This prospective study of 335 patients with penetrating injuries of the neck examined the decision whether to operate or observe according to a protocol based mainly on physical examination. Emergency angiography was performed in only three patients. Sixty-six patients (20 per cent) were subjected to emergency operation because of signs and symptoms suggestive of significant injury (60 patients) or because of positive investigations (six). The remaining 269 patients (80 per cent) were selected for non-operative management. Two of these patients (0.7 per cent) required elective operation during the initial hospital stay. No deaths occurred in patients treated conservatively. Some 192 (72 per cent) of observed patients were available for early follow-up and 111 (42 per cent) for late follow-up. No significant complications were found. Physical examination is a reliable method for detecting significant injuries following penetrating neck trauma. Emergency angiography is rarely necessary.

This prospective study includes 146 patients with gunshot wounds of the abdomen. One hundred and five patients (72 per cent) had an acute abdomen on admission and were operated on immediately. The remaining 41 patients (28 per cent) had minimal or equivocal abdominal signs and were observed with serial clinical examinations. Seven of the observed patients needed subsequent laparotomy, but there was no mortality or serious morbidity. Had a policy of mandatory exploration for abdominal gunshot wound been applied the incidence of unnecessary or negative laparotomies would have been 27 per cent. By using a policy of selective conservatism this figure was only 5 per cent. We suggest that abdominal gunshot wounds should be assessed and managed exactly like knife wounds. Physical examination is reliable in detecting significant intra-abdominal injuries. Many carefully selected patients with abdominal gunshot wounds can safely be managed non-operatively.

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