T. Swartz1, A. Azim1, K. Ibraheem1, A. Tang1, T. O’keeffe1, G. Vercruysse1, N. Kulvatunyou1, B. Joseph1 1University Of Arizona,Trauma-Department Of Surgery,Tucson, AZ, USA
Introduction:
Management of penetrating neck injuries remains a challenge to acute care surgeons. Self-inflicted injuries to the neck are a special entity that is extremely complex and difficult to manage, however literature is scarce about the seriousness and implications of these injuries. We sought to compare outcomes in patients with and without self-inflicted penetrating neck injuries.
Methods:
8-year retrospective analysis of all adult trauma patients with penetrating neck injury at a Level I trauma center. We included all patients in whom the platysma was violated. Patients were classified into two groups; self-inflicted and non-self-inflicted. Age, mechanism of injury, zone of injury, hard and soft signs, computed tomography angiography (CTA) use and operative findings were analyzed. Our outcomes were need for operative intervention and therapeutic neck exploration (defined by repair of vascular or aero digestive injuries). Univariate and multivariate regression analyses were performed. We controlled for patient and injury-related risk factors, zone of injury and hard signs.
Results:
A total of 337 patients with penetrating neck injuries met the inclusion criteria. 60 patients (17.8%) had self-inflicted injuries. 97.6% had stab/slash wounds. Patients with self-inflicted injuries had less CTA (26.7% vs. 78.0%, p<0.001), more jugular venous injuries (35.0% vs. 10.1%, p<0.001) and more laryngeal injuries (13.3% vs. 2.5%, p=0.002) when compared to patients without self-inflicted injuries. More patients in the self-inflicted group went to the operating room (78.3% vs. 33.2%, p<0.001) and had therapeutic neck exploration (72.3% vs. 54.3%, p=0.031) Table. There was no difference in the incidence of arterial, esophageal, tracheal injuries or mortality. Sustaining self-inflicted injuries was an independent predictor of need for operative intervention (OR=5.1, 95% CI 2.2-12.1, p<0.001) and therapeutic neck exploration (OR=2.8, 95% CI 1.2-6.6, p=0.018).
Conclusion:
Patients sustaining self-inflicted penetrating neck injuries have higher rates of operative intervention and therapeutic neck exploration. As we move towards an era of CTA and conservative management, a low threshold for operative intervention is advised in the approach to these challenging patients.
