Diagnostic peritoneal lavage: Is 100,000 RBCs a valid figure for penetrating abdominal trauma?

Lauren K. Thacker, Jennifer Parks, Erwin R. Thal

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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)/mm as a positive value. The false positive rate was 12.2%. The second analysis used >10,000 RBCs/mm 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/mm 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.

Original languageEnglish (US)
Pages (from-to)853-857
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume62
Issue number4
DOIs
StatePublished - Apr 2007

Fingerprint

Peritoneal Lavage
Stab Wounds
Erythrocytes
Amylases
Bile
Abdomen
Wounds and Injuries
Thorax
Erythrocyte Count
Leukocytes
Cell Count
Population

Keywords

  • Diagnostic peritoneal lavage
  • Penetrating abdominal trauma
  • Penetrating trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Diagnostic peritoneal lavage : Is 100,000 RBCs a valid figure for penetrating abdominal trauma? / Thacker, Lauren K.; Parks, Jennifer; Thal, Erwin R.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 62, No. 4, 04.2007, p. 853-857.

Research output: Contribution to journalArticle

@article{175238ae6e164dcabf200d5cbbd7fd90,
title = "Diagnostic peritoneal lavage: Is 100,000 RBCs a valid figure for penetrating abdominal trauma?",
abstract = "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)/mm as a positive value. The false positive rate was 12.2{\%}. The second analysis used >10,000 RBCs/mm 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/mm 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.",
keywords = "Diagnostic peritoneal lavage, Penetrating abdominal trauma, Penetrating trauma",
author = "Thacker, {Lauren K.} and Jennifer Parks and Thal, {Erwin R.}",
year = "2007",
month = "4",
doi = "10.1097/TA.0b013e31803245d9",
language = "English (US)",
volume = "62",
pages = "853--857",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Diagnostic peritoneal lavage

T2 - Is 100,000 RBCs a valid figure for penetrating abdominal trauma?

AU - Thacker, Lauren K.

AU - Parks, Jennifer

AU - Thal, Erwin R.

PY - 2007/4

Y1 - 2007/4

N2 - 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)/mm as a positive value. The false positive rate was 12.2%. The second analysis used >10,000 RBCs/mm 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/mm 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.

AB - 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)/mm as a positive value. The false positive rate was 12.2%. The second analysis used >10,000 RBCs/mm 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/mm 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.

KW - Diagnostic peritoneal lavage

KW - Penetrating abdominal trauma

KW - Penetrating trauma

UR - http://www.scopus.com/inward/record.url?scp=34247239362&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34247239362&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e31803245d9

DO - 10.1097/TA.0b013e31803245d9

M3 - Article

C2 - 17426539

AN - SCOPUS:34247239362

VL - 62

SP - 853

EP - 857

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 4

ER -