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Prospective Alterations in Therapy for Penetrating Abdominal Trauma

Ronald Lee Nichols, MD, MS; Jeffrey W. Smith, MS, MPH; George D. Robertson, MD; Anita C. Muzik, MT (ASCP); Patricia Pearce, RN, MPH; Vahit Ozmen, MD; Norman E. McSwain Jr, MD; Lewis M. Flint, MD
Arch Surg. 1993;128(1):55-64. doi:10.1001/archsurg.1993.01420130059010.
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• In a double-blind, randomized study, 170 patients with traumatic perforation of the gastrointestinal tract were administered an advanced-generation cephalosporin. Patients were divided into infection risk groups (≤40%, low; 40% to 70%, mid; and >70%, high) at surgical closure using a logistic regression formula based on four proved risk factors—age, blood replacement, ostomy, and the number of organs injured. Patients in the low group received 2 days of antibiotic therapy; those in the mid to high group received 5 days of antibiotic therapy. Those patients in the low to mid group had primary wound closure; those in the high group had their wounds packed open and closed later. Most of the patients (144 [85%]) were in the low group. Their major and minor infection rates (10% and 12%, respectively) were not significantly different from 145 historic control subjects receiving 5 days of antibiotic therapy (9% major; 14% minor). Patients in the mid to high group showed a greater incidence of major infections (46%) but a similar incidence of minor infections (12%). The results indicate that risk factors can be used to identify low-risk patients who require only short-term antibiotic therapy and primary wound closure. The remaining patients are at greater risk for infection despite prolonged antibiotic therapy and delayed wound closure.

(Arch Surg. 1993;128:55-64)


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