Over the last decade, the role of nonoperative management has revolutionized the specialty of trauma. However, this management paradigm has generated substantial controversy in several areas, including penetrating neck and abdominal trauma. Evidence-based analysis will be the ultimate guideline to determine what is optimal management. To prevent the pendulum from swinging too far, there should always exist a high index of suspicion to possible complications associated with the nonoperative approach. Also, the specific choice of management should be institution- and resource dependent.