Comparison between isolated serial clinical examination and computed tomography for stab wounds in the anterior abdominal wall

ABSTRACT Objective: to compare abdominal computer tomography (CT) with isolated serial clinical exam (SCE) in the management of anterior abdominal stab wounds. Methods: randomized prospective study performed at Hospital de Pronto Socorro de Porto Alegre involving patients with anterior abdominal stab wounds without indication of immediate laparotomy; patients were divided in two groups: CT group and SCE group, In the SCE group, patients were followed up with serial clinical exam every 6 hours, Patients of CT group were submitted to abdominal computer tomography after initial evaluation. Results: 66 patients were studied and 33 were included in each group, Of total, six were submitted to surgery, three of each group, In the SCE group, patients submitted to surgery in media waited 12 hours from arrival to diagnosis without any non-therapeutic surgeries, The remaining 30 patients of this group were discharged from hospital after 24 hours of observation, In the CT group, three patients showed alteration at CT and were submitted to laparotomy, one non-therapeutic, The others were discharged from hospital after 24 hours of observation, Abdominal computer tomography had a positive predictive value (PPV) of 67% and negative predictive value (NPV) of 100%, with 96% of accuracy, Isolated serial clinical exam showed PPV and NPV of 100% and 100% of accuracy. Conclusion: selective management of anterior abdominal stabs is safe, when a rigorous selection of patients is observed, Isolated serial clinical exam may be performed without computer tomography, without increase of hospitalization time or morbidity, reducing costs, exposure to radiation, mortality and morbidity and non-therapeutic laparotomies. RESUMO Objetivo: comparar tomografia computadorizada de abdome (TC) com exame clínico seriado (ECS) isolado na condução de ferimentos por arma branca na região anterior do abdome. Métodos: estudo prospectivo, randomizado, realizado no Hospital de Pronto Socorro de Porto Alegre em que pacientes com ferimentos por arma branca na parede anterior do abdome, sem indicação de laparotomia imediata, foram divididos em dois grupos: grupo TC e grupo ECS, No grupo ECS, os pacientes eram observados com exame clínico seriado de 6/6h, No grupo TC, eram submetidos à tomografia computadorizada de abdome após a avaliação inicial. Resultados: dos 66 pacientes estudados, 33 foram selecionados para cada grupo, Do total, seis foram submetidos à cirurgia, três de cada grupo, No grupo ECS, paci