UMEM Educational Pearls

Category: Trauma

Title: A new approach to penetrating neck injuries?

Posted: 11/18/2022 by Robert Flint, MD (Emailed: 11/20/2022) (Updated: 12/7/2022)
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This small study looked at patients with penetrating neck injuries and tried to determine in those with "hard signs" of injury (hemorrhage, expanding hematoma, or ischemia)  if they required immediate operative managment.  The authors concluded:

"Although hard signs in PCVIs are associated with the need for operative intervention, initial CT imaging can facilitate endovascular options or nonoperative management in a significant subgroup. Hard signs should not be considered an absolute indication for immediate surgical exploration."

This is a small study and it is unclear why some patients went to CT vs directly to the operating room. This may not be a practice changing study, but it may validate provider gestalt of CT vs direct to operating room. We can add this to the growing body of evidence that CT scanning in penetrating trauma can be used to diffrentiate who needs emergent operative intervention vs. endovascular therapy vs close observation. This study certainly opens the door for further reaserch in the area of management of penetratign neck injuries. 

References

Reading the signs in penetrating cervical vascular injuries: Analysis of hard/soft signs and initial management from a nationwide vascular trauma database

Marrotte, Alexander MD; Calvo, Richard Y. PhD; Badiee, Jayraan MPH; Rooney, Alexandra S. MPH; Krzyzaniak, Andrea MA; Sise, Michael MD; Bansal, Vishal MD; DuBose, Joseph MD; Martin, Matthew J. MD;  the AAST PROOVIT Study Group; Morrison, Jonny MD, PhD

 

Journal of Trauma and Acute Care Surgery: November 2022 - Volume 93 - Issue 5 - p 632-638

doi: 10.1097/TA.0000000000003678