Evaluation and management of abdominal gunshot wounds: A Western Trauma Association critical decisions algorithm

This is a recommended evaluation and management algorithm from the Western Trauma Association (WTA) Algorithms Committee addressing the management of adult patients with abdominal gunshot wounds (GSW). Because there is a paucity of published prospective randomized clinical trials that have generated class I data, these recommendations are based primarily on published prospective and retrospective cohort studies identified via structured literature search, and expert opinion of the WTA members. In addition to published clinical series, this algorithm attempts to incorporate and remain consistent (whenever possible) with the relevant evidence-based Eastern Association for the Surgery of Trauma Practice Management Guidelines.^1,2 The final algorithm is the result of an iterative process including an initial internal review and revision by the WTA Algorithm Committee members, and then final revisions based on input during and after presentation of the algorithm to the full WTA membership (March 2018). We believe the algorithm (Fig. 1) and accompanying comments represent a safe and well-reasoned approach to the evaluation and management of the patient with an abdominal GSW in any location (including thoracoabdominal).