Selective Nonoperative Management of Abdominal Stab Wounds in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

BackgroundSelective nonoperative management (SNOM) of abdominal stab wounds is a well-established approach to managing these injuries and has been practiced since the 1960s. This systematic review and meta-analysis provides an up-to-date analysis of the safety and feasibility of this management strategy in upper-middle-income, lower-middle-income, low-income, and least developed countries and describes evidence of how this management has evolved.MethodsMedline (via PubMed), Google Scholar, Scopus, Embase, the International Clinical Trials Registry, and Web of Science were searched for studies describing SNOM of abdominal stab wounds in patients >= 16 years old in upper-middle-income, lower-middle-income, low-income, and least developed countries. Study characteristics and method of SNOM (use of computed tomography scanning vs. serial examination only) were extracted. Pooled results for failure of SNOM, mortality, complications, and length of stay (LOS) were analyzed.ResultsTwenty studies were selected containing 1505 patients initially managed nonoperatively with 245 ultimately requiring surgical intervention. The pooled risk of failure of SNOM was 0.14 (95% CI = 0.08-0.22). There was zero reported mortality in patients selected for SNOM. LOS was generally higher in patients undergoing primary operative management, and complications were also reported as being more frequent in primary operative management patients.ConclusionSNOM of abdominal stab wounds is a safe method of managing these injuries. Computed tomography is now commonly used to aid in decision-making about suitability for attempted SNOM in lower-resource settings.