NEGATIVE TRAUMA CELIOTOMY

A retrospective review of 525 consecutive exploratory celiotomies for abdominal trauma occurring between January 1987 and June 1990 in an ur ban trauma center was conducted. One hundred-fifteen patients sustaine d blunt abdominal trauma (21%), and 410 patients sustained penetrating abdominal trauma (78%). Penetrating injuries included 260 gunshot wou nds and 150 stab wounds. Patients were divided into three groups: Grou p A (16%), no visceral injuries identified at exploration (true negati ve); Group B, positive operative findings at celiotomy requiring no op erative repair (10%) (nontherapeutic celiotomy); and Group C (74%), in juries encountered requiring operative repair (true positive). A posit ive exploration rate of 90 per cent with blunt trauma is acceptable us ing diagnostic techniques currently available. Similarly, a positive e xploration rate of 85 per cent in gunshot wounds warrants our continue d use of mandatory celiotomy. A 36 per cent combined incidence of true negatives and nontherapeutic celiotomies (Group A and B) is unaccepta bly high. To reduce this high incidence will require improved clinical surveillance and the controlled implementation of newer diagnostic te chniques.