Evidence map›Paper›PMID 39143330›Full record

ArticleSurgical endoscopy2024

Non-therapeutic laparotomies in military trauma (2009-2014).

Patrick F Walker, Joseph D Bozzay, David W Schechtman, Faraz Shaikh, Laveta Stewart, M Leigh Carson, David R Tribble, Carlos J Rodriguez, Matthew J Bradley

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Surgical endoscopy, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Patrick F WalkerWalter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA. patfwalker@gmail.com.
Joseph D BozzayWalter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA.
David W SchechtmanBrooke Army Medical Center, JBSA Fort Sam Houston, TX, USA.
Faraz ShaikhInfectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Laveta StewartInfectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
M Leigh CarsonInfectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
David R TribbleInfectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Carlos J RodriguezTexas Health Resources, Fort Worth, TX, USA.
Matthew J BradleyWalter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA.

Funding

DATA CENTER FOR EPIDEMIOLOGIC INVESTIGATIONS OF HIVN01AI005072 · NIAID · NEW ENGLAND RESEARCH INSTITUTES, INC. · PI MCKINLAY, SONJA M · 1990 to 1994
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Defense Health Program HU0001190002Division of Intramural Research, National Institute of Allergy and Infectious Diseases Y1-AI-5072NIAID NIH HHS Y01 AI005072Wounded, Ill and Injured Program, Department of Navy HU0001-10-1-0014
6 · The paper itself

Abstract

backgroundCombat casualties are frequently injured in austere settings where modern imaging modalities are unavailable. Exploratory laparotomies are often performed in these settings when there is suspicion for intra-abdominal injury. Prior studies of combat casualties reported non-therapeutic laparotomy (NTL) rates as high as 32%. Given improvements in combat casualty care over time, we evaluated NTLs performed during later years of the wars in Iraq and Afghanistan.

methodsMilitary personnel with combat-related injuries (6/1/2009-12/31/2014) who underwent exploratory laparotomy based on concern for abdominal injury (i.e. not performed for proximal vascular control or fecal diversion) and were evacuated to Landstuhl Regional Medical Center (Germany) before being transferred to participating U.S. military hospitals were assessed. An NTL was defined as a negative laparotomy without substantial intra-abdominal injuries requiring repair. Characteristics, indications for laparotomy, operative findings, and outcomes were examined.

resultsAmong 244 patients who underwent laparotomies, 41 (16.8%) had NTLs and 203 (83.2%) had therapeutic laparotomies (i.e. positive findings). Patients with NTLs had more computed tomography scans concerning for injury (48.8% vs 27.1%; p = 0.006), less penetrating injury mechanisms (43.9% vs 71.9%; p < 0.001), and lower Injury Severity Scores (26 vs 33; p = 0.003) compared to patients with therapeutic laparotomies. Patients with NTLs were also less likely to be admitted to the intensive care unit (70.7 vs 89.2% for patients with therapeutic laparotomies; p = 0.007). No patients with NTLs developed abdominal surgical site infections (SSI) compared to 16.7% of patients with therapeutic laparotomies (p = 0.002). There was no significant difference in mortality between the groups (p = 0.198).

conclusionsOur proportion of NTLs was lower than reported from earlier years during the wars in Iraq and Afghanistan. No infectious complications from NTLs (i.e. abdominal SSIs) were identified. Nevertheless, surgeons should continue to have a low threshold for exploratory laparotomy in military patients in austere settings with concern for intra-abdominal injury.

Indexed as

Abdominal InjuriesAfghan Campaign 2001-Iraq War, 2003-2011LaparotomyMilitary PersonnelAdultFemaleHumansMaleRetrospective StudiesUnited StatesWar-Related InjuriesYoung AdultCombat traumaExploratory laparotomyMilitaryNon-therapeutic laparotomySurgical site infections

Identifiers

PMID39143330
PMCPMC11458353

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.