OBJECTIVES: To determine if selective management of blunt and penetrating neck trauma is still appropriate in Canadian tertiary care centres because of differences in trauma demographics. A key secondary objective was a descriptive analysis of the Canadian head and neck trauma patient population and outcomes. DESIGN: A retrospective case series. SETTING: An academic tertiary care centre. PATIENTS: All 85 patients admitted between 1982 and 1992 with a diagnosis of blunt (19) or penetrating (66) neck trauma. INTERVENTIONS: Emergent neck explorations (29 patients), selective nonoperative management (20 patients) and elective neck exploration (17 patients). MAIN OUTCOME MEASURES: Hospital stay, complication rate, rate of negative exploration (elective management, emergent exploration) and rate of secondary exploration (selective management), and outcome and complication rate. The entire population was described demographically. RESULTS: In 66 patients the injuries were penetrating, with the majority being of low kinetic energy. The patients who underwent elective mandatory exploration were comparable to those who underwent selective nonoperative management. The length of stay in hospital for the selective group was significantly less (p = 0.0008), and no patient in this group required later operative management of a missed injury. However, 41% of patients who underwent elective mandatory neck exploration had no significant injury. The complication rate in the two groups was similar. CONCLUSIONS: The patients managed selectively had no difference in outcome from those who underwent mandatory elective exploration. In Canada, because of the lower incidence of high-morbidity zone I and zone III injuries and the high incidence of low kinetic energy trauma with a predilection to zone II, the surgeon may consider a selective approach where appropriate.
OBJECTIVES: To determine if selective management of blunt and penetrating neck trauma is still appropriate in Canadian tertiary care centres because of differences in trauma demographics. A key secondary objective was a descriptive analysis of the Canadian head and neck traumapatient population and outcomes. DESIGN: A retrospective case series. SETTING: An academic tertiary care centre. PATIENTS: All 85 patients admitted between 1982 and 1992 with a diagnosis of blunt (19) or penetrating (66) neck trauma. INTERVENTIONS: Emergent neck explorations (29 patients), selective nonoperative management (20 patients) and elective neck exploration (17 patients). MAIN OUTCOME MEASURES: Hospital stay, complication rate, rate of negative exploration (elective management, emergent exploration) and rate of secondary exploration (selective management), and outcome and complication rate. The entire population was described demographically. RESULTS: In 66 patients the injuries were penetrating, with the majority being of low kinetic energy. The patients who underwent elective mandatory exploration were comparable to those who underwent selective nonoperative management. The length of stay in hospital for the selective group was significantly less (p = 0.0008), and no patient in this group required later operative management of a missed injury. However, 41% of patients who underwent elective mandatory neck exploration had no significant injury. The complication rate in the two groups was similar. CONCLUSIONS: The patients managed selectively had no difference in outcome from those who underwent mandatory elective exploration. In Canada, because of the lower incidence of high-morbidity zone I and zone III injuries and the high incidence of low kinetic energy trauma with a predilection to zone II, the surgeon may consider a selective approach where appropriate.
Authors: Diogo Casal; Giovanni Pelliccia; Diogo Pais; Diogo Carrola-Gomes; Maria Angélica-Almeida; José Videira-Castro; João Goyri-O'Neill Journal: J Med Case Rep Date: 2017-07-29