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Computed Tomography in the Evaluation of Penetrating Neck Trauma
A Preliminary Study
Vicente H. Gracias, MD;
Patrick M. Reilly, MD;
Jonathan Philpott, MD;
Wendy P. Klein, MD;
Sun Y. Lee, MD;
Michael Singer, BS;
C. William Schwab, MD
Arch Surg. 2001;136:1231-1235.
Hypothesis Penetrating neck trauma has traditionally been evaluated by surgical exploration and/or invasive diagnostic studies. We hypothesized that computed tomography (CT), used as an early diagnostic tool to accurately determine trajectory, would direct or eliminate further studies or procedures in stable patients with penetrating neck trauma.
Design Retrospective case series.
Setting Academic, urban, level I trauma center.
Patients Hemodynamically stable patients without hard signs of vascular injury or aerodigestive violation who had sustained penetrating trauma to the neck.
Interventions Patients underwent a spiral CT as an initial diagnostic study after initial evaluation in the trauma bay. Further invasive studies were directed by CT findings.
Main Outcome Measures Number of invasive studies performed.
Results Twenty-three patients were identified during the 30-month period. Nineteen patients sustained gunshot wounds; 3, shotgun wounds; and 1, a stab wound. One patient died of a cranial gunshot wound. Three isolated zone I, 1 isolated zone II, 9 isolated zone III, and 10 multiple neck zone trajectories were evaluated. Thirteen patients were identified by CT to have trajectories remote from vital structures and required no further evaluation. Ten patients underwent angiography. Only 2 underwent bronchoscopy and esophagoscopy. Four patients were discharged from the emergency department; 7 other patients were discharged within 24 hours. No adverse patient events occurred before, during, or after CT scan.
Conclusions Computed tomography in stable selected patients with penetrating neck trauma appears safe. Invasive studies can often be eliminated from the diagnostic algorithm when CT demonstrates trajectories remote from vital structures. As a result, efficient evaluation and early discharge from the trauma bay or emergency department can be realized. Further prospective study of CT scan after penetrating neck trauma is needed.
From the Divisions of Traumatology and Surgical Critical Care (Drs Gracias, Reilly, Philpott, Lee, and Schwab and Mr Singer) and Radiology/Body Imaging (Dr Klein), University of Pennsylvania School of Medicine, Philadelphia.
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