Negative laparotomy in trauma: are we getting better?

One of the trauma surgeons' daily challenges is the balancing act between negative laparotomy and missed abdominal injury. We opted to characterize the indications that prompted a negative trauma exploratory laparotomy and the rate of missed abdominal injuries in an effort to optimize patient selection for laparotomy. At the Los Angeles County + University of Southern California Medical Center, negative laparotomies and missed injuries are consecutively captured and reviewed at the weekly mortality + morbidity (MM) conferences. All written reports of the MM meetings from January 2003 to December 2008 were reviewed to identify all patients who underwent a negative laparotomy or a laparotomy as a result of an initially missed abdominal injury. Over the 6-year study period, a total of 1871 laparotomies were performed, of which 73 (3.9%) were negative. The rate of missed injuries requiring subsequent laparotomy was 1.3 per cent (25 of 1871). The negative laparotomy rate and the rate of missed injuries did not vary significantly during the study period (2.8 to 4.7%, P = 0.875, and 0.7 to 2.9%, P = 0.689). Penetrating mechanisms accounted for the majority of negative laparotomies (58.9%). The primary indication for negative laparotomy was peritonitis (54.8%) followed by hypotension (28.8%) and suspicious computed tomographic scan findings (27.4%). The complication rate after negative laparotomy was 14.5 per cent, and of these, 10.1 per cent were directly related to the procedure. A low but steady rate of negative laparotomies and missed abdominal injuries after trauma remains. Negative laparotomies and missed abdominal injuries when they occur are still associated with significant complication rates and a prolonged length of stay.

Neck injury assessment protocol. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Albastron

4 59/64 in.x 1 59/64 in.; core-formed glass

Amphora

5 1/8 in.x 2 41/64 in.; glass with splash decoration

Laughing Child

Frans Hals; 2 ft. 9 9/16 in.x 2 ft. 3 13/64 in.; oil on canvas

Theseus Taming the Bull of Marathon

Carle van Loo; 2 ft. 2 in.x 4 ft. 10 in.; oil on canvas

In the Woods at Giverny: Blanche Hoschedé at Her Easel with Suzanne Hoschedé Reading

Claude Monet; 3 ft.x 3 ft. 2 1/2 in.; oil on canvas

Andromeda Chained to the Rock

Imitator of Sir Anthony van Dyck; 7 ft. 3/4 in.x 4 ft. 4 in.; oil on canvas

Still Life with Cheeses, Artichoke, and Cherries

Clara Peeters; 1 ft. 6 3/8 in.x 1 ft. 1 1/8 in.; oil on wood

Sanitary landfill : one part earth to four parts refuse /

"Describes the film made by the Los Angeles County Sanitation Districts for the Federal solid waste management program under contract No. PH-OS-DQ-66."

Laboratory methods.

Cover title.

Fossil birds, with especial reference to the birds of Rancho La Brea.

Includes bibliographical refernces (p.44)

1968-1973, the ten-year program at the halfway mark.

Cover title.

Publications of the Historical Society of Southern California.

Description based on: Vol. 2, pt. 1; title from cover.

New York MTA management study : summary report /

"Financed in part through funds from the U.S. Department of Transportation, Federal Highway Administration under the Federal Highway Act of 1956, as amended, and the Urban Mass Transportation Act of 1964, as amended."