Impact of self-inflicted injury on nontherapeutic laparotomy in patients with abdominal stab wounds

Shokei Matsumoto, Kei Hayashida, Shintaro Furugori, Masayuki Shimizu, Kazuhiko Sekine, Mitsuhide Kitano

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: Because Japan has high suicide rates and low violent crime rates, it is likely that most abdominal stab wounds (ASWs) in Japan are self-inflicted. Although physical examination is one of the most important factors in surgical decision making, such evaluations can be difficult in patients with self-inflicted ASWs due to patient agitation and uncooperative behavior. Therefore, the self-inflicted nature of an injury may strongly affect clinical practice, particularly in Japan, but its influence remains uncertain. We hypothesized that the rates of exploratory laparotomy and nontherapeutic laparotomy (NTL) would be higher in self-inflicted patients. Methods: We reviewed ASW patients from 2004 to 2014 in the Japan Trauma Data Bank. The rates of exploratory laparotomy and NTL were compared between self-inflicted and non-self-inflicted ASWs. Results: Of the 1705 eligible patients, 1302 patients (76.4%) had self-inflicted ASWs, and 403 patients (23.6%) had non-self-inflicted ASWs. Self-inflicted patients had a significantly higher rate of psychiatric history, but lower injury severity. The in-hospital mortality rate was similar between the two groups (4.5% vs. 5.2%, p = 0.576). Self-inflicted patients had significantly higher rates of exploratory laparotomy and NTL (69.1% vs. 56.7%, p < 0.001, 22.5% vs. 13.6%, p = 0.03, respectively). Self-inflicted patients were also associated with significantly longer hospital stays (10.0 [5.0–21.0] vs. 9.0 [4.0–18.0] days, P = 0.045). In a multivariable analysis, self-inflicted patients were independently associated with exploratory laparotomy (odds ratio [OR], 2.05; 95% confidence interval [CI]: 1.55–2.72) and NTL (OR, 1.61; 95% CI: 1.01–2.56). Conclusion: ASWs in Japan were predominantly self-inflicted. The clinical patterns of self-inflicted ASWs had some unique features. Patients with self-inflicted ASWs had higher rates of laparotomy and NTL. Further studies are needed to develop a useful protocol specific to self-inflicted ASWs.

Original languageEnglish
Pages (from-to)1706-1711
Number of pages6
JournalInjury
Volume49
Issue number9
DOIs
Publication statusPublished - 2018 Sep 1
Externally publishedYes

Fingerprint

Stab Wounds
Laparotomy
Wounds and Injuries
Japan
Odds Ratio
Confidence Intervals
Crime
Hospital Mortality
Suicide
Physical Examination
Psychiatry
Length of Stay
Decision Making

Keywords

  • Abdominal stab wounds
  • Nontherapeutic laparotomy
  • Self-inflicted injury

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Matsumoto, S., Hayashida, K., Furugori, S., Shimizu, M., Sekine, K., & Kitano, M. (2018). Impact of self-inflicted injury on nontherapeutic laparotomy in patients with abdominal stab wounds. Injury, 49(9), 1706-1711. https://doi.org/10.1016/j.injury.2018.06.001

Impact of self-inflicted injury on nontherapeutic laparotomy in patients with abdominal stab wounds. / Matsumoto, Shokei; Hayashida, Kei; Furugori, Shintaro; Shimizu, Masayuki; Sekine, Kazuhiko; Kitano, Mitsuhide.

In: Injury, Vol. 49, No. 9, 01.09.2018, p. 1706-1711.

Research output: Contribution to journalArticle

Matsumoto, S, Hayashida, K, Furugori, S, Shimizu, M, Sekine, K & Kitano, M 2018, 'Impact of self-inflicted injury on nontherapeutic laparotomy in patients with abdominal stab wounds', Injury, vol. 49, no. 9, pp. 1706-1711. https://doi.org/10.1016/j.injury.2018.06.001
Matsumoto S, Hayashida K, Furugori S, Shimizu M, Sekine K, Kitano M. Impact of self-inflicted injury on nontherapeutic laparotomy in patients with abdominal stab wounds. Injury. 2018 Sep 1;49(9):1706-1711. https://doi.org/10.1016/j.injury.2018.06.001
Matsumoto, Shokei ; Hayashida, Kei ; Furugori, Shintaro ; Shimizu, Masayuki ; Sekine, Kazuhiko ; Kitano, Mitsuhide. / Impact of self-inflicted injury on nontherapeutic laparotomy in patients with abdominal stab wounds. In: Injury. 2018 ; Vol. 49, No. 9. pp. 1706-1711.
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abstract = "Introduction: Because Japan has high suicide rates and low violent crime rates, it is likely that most abdominal stab wounds (ASWs) in Japan are self-inflicted. Although physical examination is one of the most important factors in surgical decision making, such evaluations can be difficult in patients with self-inflicted ASWs due to patient agitation and uncooperative behavior. Therefore, the self-inflicted nature of an injury may strongly affect clinical practice, particularly in Japan, but its influence remains uncertain. We hypothesized that the rates of exploratory laparotomy and nontherapeutic laparotomy (NTL) would be higher in self-inflicted patients. Methods: We reviewed ASW patients from 2004 to 2014 in the Japan Trauma Data Bank. The rates of exploratory laparotomy and NTL were compared between self-inflicted and non-self-inflicted ASWs. Results: Of the 1705 eligible patients, 1302 patients (76.4{\%}) had self-inflicted ASWs, and 403 patients (23.6{\%}) had non-self-inflicted ASWs. Self-inflicted patients had a significantly higher rate of psychiatric history, but lower injury severity. The in-hospital mortality rate was similar between the two groups (4.5{\%} vs. 5.2{\%}, p = 0.576). Self-inflicted patients had significantly higher rates of exploratory laparotomy and NTL (69.1{\%} vs. 56.7{\%}, p < 0.001, 22.5{\%} vs. 13.6{\%}, p = 0.03, respectively). Self-inflicted patients were also associated with significantly longer hospital stays (10.0 [5.0–21.0] vs. 9.0 [4.0–18.0] days, P = 0.045). In a multivariable analysis, self-inflicted patients were independently associated with exploratory laparotomy (odds ratio [OR], 2.05; 95{\%} confidence interval [CI]: 1.55–2.72) and NTL (OR, 1.61; 95{\%} CI: 1.01–2.56). Conclusion: ASWs in Japan were predominantly self-inflicted. The clinical patterns of self-inflicted ASWs had some unique features. Patients with self-inflicted ASWs had higher rates of laparotomy and NTL. Further studies are needed to develop a useful protocol specific to self-inflicted ASWs.",
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N2 - Introduction: Because Japan has high suicide rates and low violent crime rates, it is likely that most abdominal stab wounds (ASWs) in Japan are self-inflicted. Although physical examination is one of the most important factors in surgical decision making, such evaluations can be difficult in patients with self-inflicted ASWs due to patient agitation and uncooperative behavior. Therefore, the self-inflicted nature of an injury may strongly affect clinical practice, particularly in Japan, but its influence remains uncertain. We hypothesized that the rates of exploratory laparotomy and nontherapeutic laparotomy (NTL) would be higher in self-inflicted patients. Methods: We reviewed ASW patients from 2004 to 2014 in the Japan Trauma Data Bank. The rates of exploratory laparotomy and NTL were compared between self-inflicted and non-self-inflicted ASWs. Results: Of the 1705 eligible patients, 1302 patients (76.4%) had self-inflicted ASWs, and 403 patients (23.6%) had non-self-inflicted ASWs. Self-inflicted patients had a significantly higher rate of psychiatric history, but lower injury severity. The in-hospital mortality rate was similar between the two groups (4.5% vs. 5.2%, p = 0.576). Self-inflicted patients had significantly higher rates of exploratory laparotomy and NTL (69.1% vs. 56.7%, p < 0.001, 22.5% vs. 13.6%, p = 0.03, respectively). Self-inflicted patients were also associated with significantly longer hospital stays (10.0 [5.0–21.0] vs. 9.0 [4.0–18.0] days, P = 0.045). In a multivariable analysis, self-inflicted patients were independently associated with exploratory laparotomy (odds ratio [OR], 2.05; 95% confidence interval [CI]: 1.55–2.72) and NTL (OR, 1.61; 95% CI: 1.01–2.56). Conclusion: ASWs in Japan were predominantly self-inflicted. The clinical patterns of self-inflicted ASWs had some unique features. Patients with self-inflicted ASWs had higher rates of laparotomy and NTL. Further studies are needed to develop a useful protocol specific to self-inflicted ASWs.

AB - Introduction: Because Japan has high suicide rates and low violent crime rates, it is likely that most abdominal stab wounds (ASWs) in Japan are self-inflicted. Although physical examination is one of the most important factors in surgical decision making, such evaluations can be difficult in patients with self-inflicted ASWs due to patient agitation and uncooperative behavior. Therefore, the self-inflicted nature of an injury may strongly affect clinical practice, particularly in Japan, but its influence remains uncertain. We hypothesized that the rates of exploratory laparotomy and nontherapeutic laparotomy (NTL) would be higher in self-inflicted patients. Methods: We reviewed ASW patients from 2004 to 2014 in the Japan Trauma Data Bank. The rates of exploratory laparotomy and NTL were compared between self-inflicted and non-self-inflicted ASWs. Results: Of the 1705 eligible patients, 1302 patients (76.4%) had self-inflicted ASWs, and 403 patients (23.6%) had non-self-inflicted ASWs. Self-inflicted patients had a significantly higher rate of psychiatric history, but lower injury severity. The in-hospital mortality rate was similar between the two groups (4.5% vs. 5.2%, p = 0.576). Self-inflicted patients had significantly higher rates of exploratory laparotomy and NTL (69.1% vs. 56.7%, p < 0.001, 22.5% vs. 13.6%, p = 0.03, respectively). Self-inflicted patients were also associated with significantly longer hospital stays (10.0 [5.0–21.0] vs. 9.0 [4.0–18.0] days, P = 0.045). In a multivariable analysis, self-inflicted patients were independently associated with exploratory laparotomy (odds ratio [OR], 2.05; 95% confidence interval [CI]: 1.55–2.72) and NTL (OR, 1.61; 95% CI: 1.01–2.56). Conclusion: ASWs in Japan were predominantly self-inflicted. The clinical patterns of self-inflicted ASWs had some unique features. Patients with self-inflicted ASWs had higher rates of laparotomy and NTL. Further studies are needed to develop a useful protocol specific to self-inflicted ASWs.

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