Stab wounds are managed operatively and, in select cases, non-operatively, depending on a patient’s hemodynamic stability, the anatomic location of the stabbing, and whether the patient demonstrates peritoneal signs. While some studies have demonstrated that patients with injuries associated with high mortality are more likely to achieve better survival and functional outcomes at level I centers, a more recent analysis found no difference in mortality for patients with penetrating trauma presenting to a level I versus level II center. In this retrospective cohort study, 17,245 adult patients admitted to an American College of Surgeons-verified level I or II center after a torso stab wound (2010-2016) were followed up to compare time to surgical intervention and mortality rates. Of the patients included in the study, 73.2% were treated at level I centers. Patients treated at either level I or level II centers had comparable injury severity scores. Researchers found that level I centers had a higher rate of laparotomy (25.5% vs. 21.4%, p<0.001) and shorter time to laparotomy (p=0.01). There was no difference in time to thoracotomy (p=0.86). Rates of mortality after thoracotomy, however, were decreased in patients treated at level I centers (p=0.04). Overall, patients treated at level I centers had a decreased risk of mortality when compared to patients at level II centers (OR 0.67, 95% CI 0.54 to 0.85, p<0.001). This study therefore shows that patients with torso stab wounds treated at level I centers have a lower risk of mortality and decreased time to laparotomy.
Click to read the study in JAMA Surgery
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