Directed work-up of select penetrating neck injuries is safe: Hard signs continue to soften.

Autor: Filiberto DM; University of Tennessee Health Science Center, 910 Madison Ave STE 220, Memphis, TN 38163, USA. Electronic address: dfiliber@uthsc.edu., Evans CR; University of Tennessee Health Science Center, 910 Madison Ave STE 220, Memphis, TN 38163, USA., Holliday T; University of Tennessee Health Science Center, 910 Madison Ave STE 220, Memphis, TN 38163, USA., Babowice J; University of Tennessee Health Science Center, 910 Madison Ave STE 220, Memphis, TN 38163, USA., Lenart EK; University of Tennessee Health Science Center, 910 Madison Ave STE 220, Memphis, TN 38163, USA., Kerwin AJ; University of Tennessee Health Science Center, 910 Madison Ave STE 220, Memphis, TN 38163, USA., Byerly S; University of Tennessee Health Science Center, 910 Madison Ave STE 220, Memphis, TN 38163, USA.
Jazyk: angličtina
Zdroj: Injury [Injury] 2024 Sep; Vol. 55 (9), pp. 111624. Date of Electronic Publication: 2024 May 19.
DOI: 10.1016/j.injury.2024.111624
Abstrakt: Introduction: Management of penetrating neck injuries (PNIs) has evolved over time, more frequently relying on increased utilization of diagnostic imaging studies. Directed work-up with computed tomography imaging has resulted in increased use of angiography and decreased operative interventions. We sought to evaluate management strategies after directed work-up, hypothesizing increased use of non-operative therapeutic interventions and lower mortality after directed work-up.
Methods: Patients with PNI from 2017 to 2022 were identified from a single-center trauma registry. Demographics, injuries, physical exam findings, diagnostic studies and interventions were collected. Patients were stratified by presence of hard signs and management strategy [directed work-up (DW) and immediate operative intervention (OR)] and compared. Outcomes included therapeutic non-operative intervention [endovascular stent, embolization, dual antiplatelet therapy (DAPT), or anticoagulation (AC)], non-therapeutic neck exploration, length of stay (LOS), and mortality.
Results: Of 436 patients with PNI, 143 (33%) patients had vascular and/or aerodigestive injuries. Of these, 115 (80%) patients underwent DW and 28 (20%) patients underwent OR. There were no differences in demographics or injury severity score between groups. Patients in the DW group were more likely to undergo vascular stent or embolization (p = 0.040) and had fewer non-therapeutic neck explorations (p = 0.0009), compared to the OR group. There were no differences in post-intervention stroke, leak, or mortality. Sixty percent of patients with vascular hard signs and 78% of patients with aerodigestive hard signs underwent DW.
Conclusions: Directed work-up in select patients with PNI is associated with fewer non-therapeutic neck explorations. There was no difference in mortality. Selective use of endovascular management, AC and DAPT is safe.
Competing Interests: Declaration of competing interest None.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: