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Penetrating neck trauma and the need for surgical exploration: six-year experience within a regional trauma centre

Published online by Cambridge University Press:  05 December 2016

A V Kasbekar ,
E J Combellack ,
S G Derbyshire  and
A C Swift
A V Kasbekar*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Aintree University Hospital, Liverpool Department of Otolaryngology, Head and Neck Surgery, Nottingham University Hospitals, Nottingham
E J Combellack
Affiliation:
Medical School, Swansea University, Wales, UK
S G Derbyshire
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Aintree University Hospital, Liverpool
A C Swift
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Aintree University Hospital, Liverpool
*
Address for correspondence: Mr Anand Kasbekar, Consultant Otologist & ENT Surgeon, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK Fax: 0115 9709748 E-mail: Anand.Kasbekar@nhs.net
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Abstract

Background:

There has been a shift towards conservative management of penetrating neck trauma in selected patients.

Methods:

A retrospective case note review of the management of penetrating neck trauma (2007–2013) was undertaken at our large teaching hospital and compared against best-evidenced practice.

Results:

Sixty-three patients were admitted over six years. The incidence of penetrating neck trauma is reducing, contrary to our belief. Most cases were knife inflicted (33 out of 63), and of these most were attempted suicide. There was a high rate of negative findings for neck explorations under general anaesthesia (18 out of 22). Only nine cases had justification for general anaesthesia exploration according to best practice.

Conclusion:

The rate of neck explorations under general anaesthesia has dramatically fallen, in line with best practice. The need for operative intervention in patients with penetration of the aerodigestive tract or a major vascular injury should be based on clinical features, and these have been shown to be reliable indicators prior to open exploration.

Keywords

Neck InjuriesPenetrating WoundsPractice Guideline
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 1 , January 2017 , pp. 8 - 12
Copyright
Copyright © JLO (1984) Limited 2016 

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Footnotes

Presented at the British Academic Conference in Otolaryngology, 8–10 July 2015, Liverpool, UK.

References

1 Siau, RT, Moore, A, Ahmed, T, Lee, MS, Tostevin, P. Management of penetrating neck injuries at a London trauma centre. Eur Arch Otorhinolaryngol 2013;270:2123–8CrossRefGoogle Scholar
2 Harris, R, Olding, C, Lacey, C, Bentley, R, Schulte, KM, Lewis, D et al. Changing incidence and management of penetrating neck injuries in the South East London trauma centre. Ann R Coll Surg Engl 2012;94:240–4CrossRefGoogle Scholar
3 House of Commons Library. Knife Crime Statistics, 2012. In http://researchbriefings.files.parliament.uk/documents/SN04304/SN04304.pdf [1 November 2016]Google Scholar
4 Mahmoodie, M, Sanei, B, Moazeni-Bistgani, M, Namgar, M. Penetrating neck trauma: review of 192 cases. Arch Trauma Res 2012;1:14–18 CrossRefGoogle ScholarPubMed
5 Burgess, CA, Dale, OT, Almeyda, R, Corbridge, RJ. An evidence based review of the assessment and management of penetrating neck trauma. Clin Otolaryngol 2012;37:44–52 CrossRefGoogle ScholarPubMed
6 Brennan, J. Head and neck trauma in Iraq and Afghanistan: different war, different surgery, lessons learned. Laryngoscope 2013;123:2411–17CrossRefGoogle ScholarPubMed
7 Brennan, J, Lopez, M, Gibbons, MD, Hayes, D, Faulkner, J, Dorlac, WC et al. Penetrating neck trauma in Operation Iraqi Freedom. Otolaryngol Head Neck Surg 2011;144:180–5CrossRefGoogle ScholarPubMed
8 Daniel, Y, de Regloix, S, Kaiser, E. Use of a gum elastic bougie in a penetrating neck trauma. Prehosp Disaster Med 2014;29:212–13CrossRefGoogle Scholar
9 Brywczynski, JJ, Barrett, TW, Lyon, JA, Cotton, BA. Management of penetrating neck injury in the emergency department: a structured literature review. Emer Med J 2008;25:711–15CrossRefGoogle ScholarPubMed
10 Thoma, M, Navsaria, PH, Edu, S, Nicol, AJ. Analysis of 203 patients with penetrating neck injuries. World J Surg 2008;32:2716–23CrossRefGoogle ScholarPubMed
11 Beebe, GW, DeBakey, ME. Battle Casualties. Springfield, IL: Charles C Thomas, 1952 Google Scholar
12 Demetriades, D, Theodorou, D, Cornwell, E, Berne, TV, Asensio, J, Belzberg, H et al. Evaluation of penetrating injuries of the neck: prospective study of 223 patients. World J Surg 1997;21:41–7CrossRefGoogle ScholarPubMed
13 Saletta, JD, Lowe, RJ, Lim, LT, Thornton, J, Delk, S, Moss, GS. Penetrating trauma of the neck. J Trauma 1976;16:579–87Google ScholarPubMed
14 Jarvik, JG, Philips, GR 3rd, Schwab, CW, Schwartz, JS, Grossman, RI. Penetrating neck trauma: sensitivity of clinical examination and cost-effectiveness of angiography. Am J Neuroradiol 1995;16:647–54Google ScholarPubMed
15 Elerding, SC, Manart, FD, Moore, EE. A reappraisal of penetrating neck injury management. J Trauma 1980;20:695–7CrossRefGoogle ScholarPubMed
16 Biffl, WL, Moore, EE, Rehse, DH, Offner, PJ, Franciose, RJ, Burch, JM. Selective management of penetrating neck trauma based on cervical level of injury. Am J Surg 1997;174:678–82CrossRefGoogle ScholarPubMed
17 Merion, RM, Harness, JK, Ramsburgh, SR, Thompson, NW. Selective management of penetrating neck trauma. Cost implications. Arch Surg 1981;116:691–6CrossRefGoogle ScholarPubMed
18 Shotton, JC. Stab wounds of the neck–observations on management. Clin Otolaryngol 1988;13:335–9CrossRefGoogle ScholarPubMed
19 Wood, J, Fabian, TC, Mangiante, EC. Penetrating neck injuries: recommendations for selective management. J Trauma 1989;29:602–5CrossRefGoogle ScholarPubMed
20 Office for National Statistics. Recorded Offences Involving the Use of Weapons, 2014. In: http://webarchive.nationalarchives.gov.uk/20160105160709/http://www.ons.gov.uk/ons/dcp171776_352297.pdf [1 November 2016]Google Scholar
21 Office for National Statistics. Suicides in the United Kingdom: 2012 Registrations. In: http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2014-02-18 [1 November 2016]Google Scholar
22 Shiroff, AM, Gale, SC, Martin, ND, Marchalik, D, Petrov, D, Ahmed, MH et al. Penetrating neck trauma: a review of management strategies and discussion of the ‘No Zone’ approach. Am Surg 2013;79:23–9CrossRefGoogle ScholarPubMed
23 Munera, F, Soto, JA, Nunez, D. Penetrating injuries of the neck and the increasing role of CTA. Emerg Radiol 2004;10:303–9Google ScholarPubMed
24 Madiba, TE, Muckart, DJ. Penetrating injuries to the cervical oesophagus: is routine exploration mandatory? Ann R Coll Surg Engl 2003;85:162–6CrossRefGoogle Scholar