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Gunshot wounds to the buttocks: predicting the need for operation
G C Velmahos1, D Demetriades, E E Cornwell
1Department of Surgery, University of Southern California, Los Angeles, USA.
Diseases of the Colon and Rectum
|March 1, 1997
Summary
Clinical examination safely manages gunshot wounds to the buttocks, avoiding unnecessary surgery. This approach accurately identifies patients needing intervention, preventing delays and improving outcomes for buttock gunshot injuries.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Surgical Triage
Background:
- Gunshot wounds to the buttocks can lead to serious intra-abdominal injuries.
- Aggressive exploration or extensive diagnostics are traditional management strategies.
- Clinical examination has emerged as a potentially reliable triage tool.
Purpose of the Study:
- To evaluate the efficacy of selective clinical management for buttock gunshot wounds.
- To test the hypothesis that clinical findings alone can guide treatment decisions.
Main Methods:
- A retrospective analysis of 59 consecutive patients with buttock gunshot wounds at a Level I trauma center.
- Patients were managed based on clinical assessment over a 12-month period.
- Data collected included operative findings, diagnostic tests, and patient outcomes.
Main Results:
- 19 patients (32.2%) underwent surgery, with 17 (28.8%) having significant intra-abdominal injuries.
- 40 patients (67.8%) were managed nonoperatively with successful outcomes.
- Clinical examination demonstrated 100% sensitivity and 95.3% specificity for detecting significant injuries, with no missed diagnoses.
Conclusions:
- Clinical examination is a safe and effective method for selecting patients with buttock gunshot wounds for nonoperative management.
- Selective nonoperative treatment based on clinical findings can be safely implemented.
- This approach reduces unnecessary interventions and potential complications.