Computed tomography angiography in the 'no-zone' approach era for penetrating neck trauma: A systematic review
| Autor: | Sunnie Wong, Juan Duchesne, Patrick McGrew, Rebecca Schroll, Chrissy Guidry, Sharven Taghavi, Charles Harris, Clifton McGinness, Alison Smith, Kareem Ibraheem |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test Computed Tomography Angiography business.industry MEDLINE Wounds Penetrating 030208 emergency & critical care medicine Retrospective cohort study Physical examination Evidence-based medicine Critical Care and Intensive Care Medicine medicine.disease Neck Injuries 03 medical and health sciences 0302 clinical medicine Angiography medicine Humans Surgery Radiology business Physical Examination Neck trauma Penetrating trauma Computed tomography angiography |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 89:1233-1238 |
| ISSN: | 2163-0763 2163-0755 2000-2017 |
| Popis: | Background Penetrating neck trauma continues to present a diagnostic dilemma. Practice guidelines advocate the use of computed tomography angiography (CTA) for suspected vascular or aero-digestive injuries in all neck zones. There is also an evolving evidence of 'No Zone' approach where the decision to obtain a CTA is guided by physical exam findings and clinical presentation. The aim of this systematic review is to examine existing literature on the diagnostic accuracy of CTA as an integral component of the "no zone" approach in stable patients witt penetrating neck trauma. Methods We performed a systematic review using an electronic search of three databases (PubMed, Medline, Cochrane Review) from 2000-2017. Results A total of 5 prospective and 8 retrospective studies were included. The sensitivity of CTA ranged from 83-100%; specificity, 61-100%; positive predictive value, 30-100% and negative predictive value, 90-100%. Three studies reported high sensitivity and specificity for the detection of vascular injuries, but low specificity for aero-digestive tract injuries. When stratified by clinical presentation, CTA had a sensitivity of 89.5-100% and specificity of 61-100% in stable patients presenting with soft signs. In a combined group of stable patients with either hard signs or soft signs, the sensitivity of CTA was 94.4-100% and specificity 96.7-100%. Among patients presenting with hard signs, the sensitivity of CTA was 78.6-90% and specificity is 100%. Conclusions This is the first systematic review to examine the role of computed tomography angiography in penetrating neck trauma. In combination with physical exam, CTA demonstrated a reliable high sensitivity and specificity for detecting injuries in penetrating neck trauma in stable patients with soft signs of injury and select patients with hard signs of injury. These results support the management of penetrating neck trauma using "no zone" approach based on physical examination and the use of CTA in stable patients. Level of evidence Systematic Review, level IV. |
| Databáze: | OpenAIRE |
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