M. Gayed1, A. Ekeh1 1Wright State University,Surgery,Dayton, OH, USA
Introduction:
Penetrating Injuries to the neck in hemodynamically stable patients without “hard signs” have been traditionally managed selectively with angiography, bronchoscopy, esophagogram and esophagoscopy. Some recent studies have demonstrated Computerized Tomography (CT) angiography and physical examination can be used in lieu of these studies. We sought to identify any enduring role for these traditional studies in the era of CT scan.
Methods:
All patient with who sustained penetrating neck injury over a 10 yr. period (Jan 2006 – Dec 2015) who presented to an ACS verified Level I Trauma center were identified from the trauma registry. Demographic data, surgical procedures performed, investigative studies performed including CT angiography of the neck, bronchoscopy, esophagoscopy, esophagograghy were noted.
Results:
Over the specified period, there were 171 patients (109 stab wounds, 48 stab woumds, 14 other) identified with penetrating neck injuries. Mean age was 37 yrs., average ISS 7.3 and 83 % were male. Of these, 52 patients went directly to the operating room (OR) for neck exploration without CT, for “hard signs”. CT scans were performed in 100 patients and an additional 53 patients were taken to the OR based on the CT findings. In all, 51 % of CTs were considered to be positive with 17% of them demonstrating vascular injuries. Bronchoscopy was performed in 25 patients, esophagoscopy in 28 and Esophagography in 9 patients. These three studies yielded no additional findings when performed. There were no missed injuries.
Conclusion:
In hemodynamically stable penetrating neck trauma patients without hard signs, CT angiography appears to be an adequate modality for identifying injuries. Bronchoscopy, esophagoscopy and esophagography yield no additional information. Outside specific indications demonstrated by physical examination or CT, these studies appear to be no more relevant and unnecessary in the routine management of these patients.