WESTPORT, CT (Reuters Health) – Penetrating neck trauma is typically thought of as an injury requiring surgical exploration and/or invasive diagnostic testing. However, a report published in the November issue of the Archives of Surgery indicates that CT evaluation can often eliminate the need for invasive testing.
Dr. Vicente H. Gracias and colleagues, from the University of Pennsylvania School of Medicine in Philadelphia, evaluated spiral CT as the initial diagnostic study in 23 patients with penetrating neck trauma. All of the patients were hemodynamically stable with no definitive signs of vascular injury or aerodigestive tract violation.
The study group included 19 patients with gunshot wounds, three with shotgun wounds, and one with a stab wound. In terms of anatomic location, three patients had isolated zone I injuries, one had an isolated zone II injury, nine had isolated zone III injuries, and the remaining patients had multiple neck zone injuries.
Thirteen patients had CT findings that suggested intact vital structures and these patients required no further evaluation, the authors note. The remaining ten patients had suspicious CT findings and underwent angiography. Two of these patients also underwent bronchoscopy and esophagoscopy.
Four patients were discharged from the emergency department and an additional seven patients were discharged within 24 hours of admission. The average length of stay for patients admitted to the hospital was 4 days.
In hemodynamically stable patients with penetrating neck injury, spiral CT can determine bullet or knife trajectory and whether vital structures may have been injured, the researchers conclude. "As a result, efficient evaluation and early discharge from the trauma bay or emergency department can be realized," they state. However, prospective studies are needed to validate this approach.
Arch Surg 2001;136:1231-1235.
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