everything (b)old is (k)new again....

[caesar ursic]

For those of you bemoaning the death of the Diagnostic Peritoneal Lavage in
trauma, and especially for those of you championing the use of laparasocopy
in stable/asymptomatic patients with anterior abdominal stab wounds, I refer
you to an article in the latest Journal of Trauma out of Parkland Hospital
in Dallas (abstract below) showing that the false positive (i.e.
nontherapeutic laparotomy) rate was only 12.2% and the missed injury rate
was 0.0% (that's a 'zero') when DPL was used to 'screen' these patients.
 Diagnostic peritoneal lavage: is 100,000 RBCs a valid figure for
penetrating abdominal trauma?

   - *Thacker LK*<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_AbstractPlus&term=%22Thacker+LK%22%5BAuthor%5D>,

   - *Parks J*<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_AbstractPlus&term=%22Parks+J%22%5BAuthor%5D>,

   - *Thal ER*<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_AbstractPlus&term=%22Thal+ER%22%5BAuthor%5D>.


Department of Surgery, Division of Burns, Trauma and Critical Care,
University of Texas Southwestern Medical School, Texas, USA.

BACKGROUND: Controversy exists regarding the interpretation of diagnostic
peritoneal lavage results. This is especially true in the evaluation of
patients sustaining penetrating trauma, specifically stab wounds to the
lower chest and abdomen. Ideally one wants to avoid missed injuries and
minimize unnecessary operations. METHODS: This is a retrospective review of
195 patients sustaining stab wounds to the anterior lower chest and abdomen
at Parkland Memorial Hospital between 1993 and 2005, looking at missed
injuries and false positive rates using red cell counts of 100,000, 10,000,
and the standard criteria for blunt trauma including >500 white blood cells
(WBCs), amylase, and/or bile. RESULTS: The first analysis used >100,000 red
blood cells (RBCs)/mm3 as a positive value. The false positive rate was
12.2%. The second analysis used >10,000 RBCs/mm3 as a positive value with a
false positive rate of 44%. When considering the entire study population
(195 patients), the false positive rate increased when using the lower
number (>10,000) from 2.5% to 15.8% (p < 0.001). There were no missed
injuries when using >100,000 red cells and/or >500 white cells, the presence
of bile or amylase. CONCLUSION: Decreasing the red blood cell count from
>100,000 to >10,000 as the criteria for operating on patients with stab
wounds to the anterior lower chest and/or abdomen will significantly
increase the number of nontherapeutic procedures. Based on this study,
>100,000 RBCs/mm3 appears to be a valid and safe number to use when
evaluating these patients, particularly when used with other positive
criteria such as increased white cells, bile, and amylase.

PMID: 17426539 [PubMed - in process]