Role of computed tomography angiography in the management of Zone II penetrating neck trauma in patients with clinical hard signs

The Journal of Trauma and Acute Care Surgery
Rebecca SchrollJuan Duchesne

Abstract

The Western Trauma Association (WTA) describes the management of Zone 2 penetrating neck trauma (PNT) and recommends neck exploration (NE) for patients with clinical hard signs (HS). We hypothesize that in stable patients with HS, the management of PNT augmented by computed tomography angiography (CTA) results in fewer negative NE results. This was a 4-year retrospective review of adult patients with Zone 2 PNT at a Level I trauma center. Stable patients with WTA-defined HS (airway compromise, massive subcutaneous emphysema/air bubbling through wound, expanding/pulsatile hematoma, active bleeding, shock, focal neurologic deficit, and hematemesis) who underwent CTA instead of emergent exploration were identified. Sensitivity, specificity, positive predictive value, and negative predictive value for CTA were calculated. A comparison was made between the rates of negative NE results in patients with HS who received a CTA versus the rate that would have occurred in the same patients if the WTA algorithm had been followed. Missed injury rates were also compared. Of 183 PNT patients, 23 had HS and underwent CTA. Of the 23, 5 had a positive CTA findings and underwent NE, while 17 had a negative CTA findings and did not require NE. The...Continue Reading

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Citations

Apr 27, 2016·The Journal of Trauma and Acute Care Surgery·Kareem Ibraheem, Bellal Joseph
Jun 21, 2019·European Archives of Oto-rhino-laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery·Daniele BorsettoPaul Pracy
Sep 7, 2017·Current Opinion in Otolaryngology & Head and Neck Surgery·Elisa IllingCecelia E Schmalbach
Sep 6, 2020·The Journal of Trauma and Acute Care Surgery·Kareem IbraheemRebecca Schroll
Jul 31, 2019·Cirugía española·Patrizio PetroneD'Andrea K Joseph
Jan 23, 2021·ANZ Journal of Surgery·Meera L ChandrananthDavid J Read
Dec 12, 2020·Annals of Surgical Treatment and Research·Ji Wool KoPil Young Jung
Sep 20, 2020·Annals of Vascular Surgery·Ashton B ChristianJeffry Nahmias
May 22, 2021·Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists·Hossam AbdouJonathan J Morrison
May 23, 2021·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Lorenzo PaladinoRichard Sinert

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