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Although abdominal trauma has been described since antiquity, formal laparotomies for trauma were not performed until the 1800s. Even with the introduction of general anesthesia in the United States during the years 1842 to 1846, laparotomies for abdominal trauma were not performed during the Civil War. The first laparotomy for an abdominal gunshot wound in the United States was finally performed in New York City in 1884. An aggressive operative approach to all forms of abdominal trauma till the establishment of formal trauma centers (where data were analyzed) resulted in extraordinarily high rates of nontherapeutic laparotomies from the 1880s to the 1960s. More selective operative approaches to patients with abdominal stab wounds (1960s), blunt trauma (1970s), and gunshot wounds (1990s) were then developed. Current adjuncts to the diagnosis of abdominal trauma when serial physical examinations are unreliable include the following: 1) diagnostic peritoneal tap/lavage, 2) surgeon-performed ultrasound examination; 3) contrast-enhanced CT of the abdomen and pelvis; and 4) diagnostic laparoscopy. Operative techniques for injuries to the liver, spleen, duodenum, and pancreas have been refined considerably since World War II. These need to be emphasized repeatedly in an era when fewer patients undergo laparotomy for abdominal trauma. Finally, abdominal trauma damage control is a valuable operative approach in patients with physiologic exhaustion and multiple injuries.
Epidemiology of Trauma
THERE ARE APPROXIMATELY 5.1 million deaths from injuries around the world each year. More than 2/3 of these occur in males, and more than 50 per cent occur in males 10 to 24 years of age. Norton and Kobusingye have noted that data from the World Health Organization document that trauma causes 6 per cent of all deaths in high-income countries.1 By contrast, deaths from injuries account for 11 to 12 per cent of all deaths in low-income countries in Southeast Asia and "in the Americas."
In the United States, there are 150,000 deaths from injuries each year or 54.4 injury deaths for 100,000 population. There are 400 injury deaths per day, and trauma continues to be the most common cause of death for Americans aged 1 to 44 years.2 Of interest, firearms continue to be the second leading cause of trauma deaths in the United States after motor vehicle crashes with an average of 32,300 deaths...