Results of Selective Non-Operative Management for Penetrating Neck Trauma in 594 patients.

Abstract

Background: The management of penetrating neck trauma (PNT) evolved from a policy of mandatory exploration to one of selective non-operative management (SNOM) based on clinical examination, and the liberal use of Computed Tomography Angiography (CTA) irrespective of the zone of injury for those patients who are stable on presentation.
 Methods: A retrospective audit of patients with penetrating neck injuries managed at Chris Hani Baragwanath Academic Hospital (CHBAH) Trauma Unit, from 2010 to 2015 was conducted. Statistical analysis was performed for all collected variables. A p-value of ≤ 0.05 was considered statistically significant. 
 Results: The results of treatment of 594 patients were reviewed. There was a predominance of young males (93.4%) with a median age of 28 years (IQR 18-67) presenting with injuries in zone 2, left side of the neck, commonly due to stab wounds (89.3%). Immediate surgical exploration was needed in 145(24.4%), while the remaining (75.4%) were investigated with CTA. CTA showed a sensitivity and specificity of over 90% for vascular injuries and more than 80% for aerodigestive injuries. Major vascular injuries were the most common surgical finding. The overall negative exploration rate was 6%, and the mortality 2.5%.
 Conclusions: Our unit’s SNOM protocol relies on liberal CTA use. Despite the obvious limitations of a retrospective study our results showed an acceptable negative and non-therapeutic exploration rate and a low incidence of complications and mortality.