TY - JOUR
T1 - Penetrating Neck Injury in Two Dutch Level 1 Trauma Centres
T2 - the Non-Existent Problem
AU - Hundersmarck, Dennis
AU - Reinders Folmer, Eline
AU - de Borst, Gert J
AU - Leenen, Luke P H
AU - Vriens, Patrick W H E
AU - Hietbrink, Falco
N1 - Funding Information:
1. Trauma database, University Medical Centre Utrecht, Utrecht, The Netherlands. 2. Trauma database, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands.
Publisher Copyright:
© 2019 European Society for Vascular Surgery
PY - 2019/9
Y1 - 2019/9
N2 - OBJECTIVES: Penetrating neck injuries (PNIs) have a low incidence in European trauma populations. Selective non-operative management of PNI has been suggested as a safe alternative to standard surgical neck exploration, but evidence is lacking. This clinical scenario evaluates institutional PNI management, specifically the associated carotid artery injury, and compares it with current guidelines.METHODS: Retrospectively, PNI patients presenting at two Dutch level 1 trauma centres from 2007 to 2015, were identified. International guidelines on PNI management were reviewed and recommendations were assessed in relation to current institutional management, and considering an illustrative case.RESULTS: Two current guidelines on PNI management were reviewed. Both advocate a zone based approach; one recommends a prominent role for computed tomography angiography (CTA) scanning in stable patients, supplemented by endoscopy when indicated. A combined total of 43 PNI patients were identified over a nine year period. Haemodynamically unstable patients and patients with other hard signs (i.e. active bleeding, expanding haematoma, air/saliva leak, massive subcutaneous emphysema) received immediate exploration (n = 9). Haemodynamically stable patients and those responding to resuscitation (transient responders) had a CTA scan (n = 31). Three asymptomatic patients were treated conservatively, and had an uncomplicated clinical course regarding the PNI. In 10 of 14 patients who received surgical exploration, a significant vascular or aerodigestive injury was found and repaired (71%). All patients treated conservatively after CTA scanning had an uncomplicated clinical course regarding the PNI (n = 17). Six patients with penetrating carotid artery injury underwent primary arterial reconstruction, of whom five survived.CONCLUSIONS: This clinical scenario evaluates institutional management in two trauma centres for PNI and associated carotid artery injury, and compares it to current guidelines. In comparison with guideline recommendations, CTA scanning and the so called "No zone" approach appears to have assumed a more prominent role in management of PNI.
AB - OBJECTIVES: Penetrating neck injuries (PNIs) have a low incidence in European trauma populations. Selective non-operative management of PNI has been suggested as a safe alternative to standard surgical neck exploration, but evidence is lacking. This clinical scenario evaluates institutional PNI management, specifically the associated carotid artery injury, and compares it with current guidelines.METHODS: Retrospectively, PNI patients presenting at two Dutch level 1 trauma centres from 2007 to 2015, were identified. International guidelines on PNI management were reviewed and recommendations were assessed in relation to current institutional management, and considering an illustrative case.RESULTS: Two current guidelines on PNI management were reviewed. Both advocate a zone based approach; one recommends a prominent role for computed tomography angiography (CTA) scanning in stable patients, supplemented by endoscopy when indicated. A combined total of 43 PNI patients were identified over a nine year period. Haemodynamically unstable patients and patients with other hard signs (i.e. active bleeding, expanding haematoma, air/saliva leak, massive subcutaneous emphysema) received immediate exploration (n = 9). Haemodynamically stable patients and those responding to resuscitation (transient responders) had a CTA scan (n = 31). Three asymptomatic patients were treated conservatively, and had an uncomplicated clinical course regarding the PNI. In 10 of 14 patients who received surgical exploration, a significant vascular or aerodigestive injury was found and repaired (71%). All patients treated conservatively after CTA scanning had an uncomplicated clinical course regarding the PNI (n = 17). Six patients with penetrating carotid artery injury underwent primary arterial reconstruction, of whom five survived.CONCLUSIONS: This clinical scenario evaluates institutional management in two trauma centres for PNI and associated carotid artery injury, and compares it to current guidelines. In comparison with guideline recommendations, CTA scanning and the so called "No zone" approach appears to have assumed a more prominent role in management of PNI.
KW - Adult
KW - Carotid Artery Injuries/diagnosis
KW - Computed Tomography Angiography
KW - Conservative Treatment/methods
KW - Female
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Neck Injuries/diagnosis
KW - Netherlands/epidemiology
KW - Practice Guidelines as Topic
KW - Retrospective Studies
KW - Trauma Centers
KW - Vascular Surgical Procedures/methods
KW - Wounds, Penetrating/diagnosis
KW - Penetrating neck injury
KW - Carotid artery injury
KW - Selective management
KW - Trauma centre
UR - http://www.scopus.com/inward/record.url?scp=85068774993&partnerID=8YFLogxK
U2 - 10.1016/j.ejvs.2019.04.020
DO - 10.1016/j.ejvs.2019.04.020
M3 - Review article
C2 - 31307866
SN - 1078-5884
VL - 58
SP - 455
EP - 462
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
IS - 3
ER -