Researchers at The Johns Hopkins School of Medicine (Baltimore, MD, USA) and Aga Khan University (Karachi, Pakistan) reviewed a total of 12,707 patients with abdominal gunshot and 13,030 patients with knife wounds identified from the US National Trauma Data Bank between 2002 and 2008. Patients with PAI were categorized as those who underwent successful SNOM (no operative management required) and those who failed SNOM (surgery was required more than four hours after admission). Yearly rates of SNOM versus nontherapeutic laparotomy (NTL) were plotted, and regression analysis was performed to identify factors associated with failed SNOM and mortality.

The results showed that just over 22% of the gunshot wounds were treated using SNOM, together with just under 34% of stab wounds. The remainder of the surviving patients received NTL surgery. Failure rates fell from 33% to 20% over the study period (a reduction of 37%), most within 24 hours. The percentage of failed SNOM patients who went on to have surgery was almost the same as the percentage operated on immediately (19% versus 18% respectively). After adjusting for injury severity, demographics, and clinical variables, patients who failed SNOM were four-and-a-half times more likely to die than those successfully managed without surgery. The study was published in the January 2011 Trauma Supplement of the British Journal of Surgery (BJS).

“The results show that SNOM has a success rate of up to 80% in select patients; improved diagnostic imaging has made it easier to identify suitable patients and use of the technique has become more widespread,” said study coauthor associate professor of surgery Adil Haider, MD, codirector of the Center for Surgery, Trials and Outcomes Research at Johns Hopkins. “And they demonstrate that correctly selecting patients for nonoperative management leads to shorter hospital stays, better outcomes and reduced pressure on healthcare budgets.”

“SNOM failure, which is most common in patients with severe injuries, those needing blood transfusions and those with spleen injuries, is independently associated with increased death rates and longer hospital stays,” added Dr. Haider. “In most instances, failed SNOM was associated with increased death rates, underlining the importance of careful patient selection and protocols to reduce failure rates.”

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Johns Hopkins School of Medicine
Aga Khan University