This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal

Physical Examination, Angiography, or Color Flow Doppler Imaging

D. Demetriades, MD, PhD; D. Theodorou, MD; E. Cornwell, III; F. Weaver, MD; A. Yellin, MD; G. Velmahos, MD; T. V. Berne, MD

Arch Surg. 1995;130(9):971-975.

Abstract
Background
The initial assessment of penetrating injuries of the neck is controversial, with angiography remaining the gold standard for identifying vascular injuries. Recent reports suggest that physical examination might be an accurate way to evaluate these injuries. Color flow Doppler imaging has been used with promising results to assess extremity injuries, but the role of color flow Doppler imaging in neck injuries has not been studied.

Objective
To evaluate and compare the roles of physical examination, color flow Doppler imaging, and angiography in the identification and management of penetrating neck injuries.

Study Design
A prospective study of patients in stable condition with penetrating injuries of the neck. All study patients were examined according to a written clinical protocol and subsequently underwent angiography and color flow Doppler imaging. The sensitivity and specificity of physical examination and color flow Doppler imaging were compared with those of angiography.

Results
Eighty-two patients fulfilled the criteria for inclusion in the study. Angiography demonstrated vascular lesions in 11 patients (13.4%), but only two (2.4%) of them required treatment. Serious injuries were detected or suspected during physical examination, but six lesions not requiring treatment were missed. When injuries not requiring treatment were excluded, the sensitivity was 100% and the specificity was 91%. With color flow Doppler imaging, 10 of the 11 injuries were identified, for a sensitivity of 91% and a specificity of 98.6%. The sensitivity and specificity were 100% for clinically important lesions.

Conclusion
The combination of a careful physical examination and color flow Doppler imaging provides a reliable way to assess penetrating neck trauma and may be a safe alternative to routine contrast angiography.

(Arch Surg. 1995;130:971-975)

Author Affiliations
From the Department of Surgery, University of Southern California School of Medicine, Los Angeles.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Management of penetrating neck injury in the emergency department: a structured literature review
Brywczynski et al.
Emerg. Med. J. 2008;25:711-715.
ABSTRACT | FULL TEXT  

The early hospital management of gunshot wounds. Part 1: head, neck and thorax
Garner
Trauma 2005;7:143-154.
ABSTRACT  

Blunt Carotid Artery Injury: The Futility of Aggressive Screening and Diagnosis
Mayberry et al.
Arch Surg 2004;139:609-613.
ABSTRACT | FULL TEXT  

Penetrating Neck Injuries: Helical CT Angiography for Initial Evaluation
Munera et al.
Radiology 2002;224:366-372.
ABSTRACT | FULL TEXT  

Penetrating neck injury: a review
MacFarlane and Benn
Trauma 2002;4:79-90.
ABSTRACT  

Diagnosis of Arterial Injuries Caused by Penetrating Trauma to the Neck: Comparison of Helical CT Angiography and Conventional Angiography
Múnera et al.
Radiology 2000;216:356-362.
ABSTRACT | FULL TEXT  

"Alternative" Surgery in Trauma Management
Britt and Cole
Arch Surg 1998;133:1177-1181.
ABSTRACT | FULL TEXT  

The Use of Duplex Ultrasonography in Penetrating Neck Trauma
Ginzburg et al.
Arch Surg 1996;131:691-693.
ABSTRACT