A 10-year study of penetrating head and neck injury by assault in the North East of England

Abstract

Introduction Assaults inflicting penetrating head and neck trauma have potential for serious morbidity or mortality. This paper studies in-depth all cases treated at a level one trauma centre in the North East of England over 10 years. Methods All patients assaulted with sharp implements to the head and neck treated from 2010 to 2019 were identified using clinical codes. Results Retrospective data collection were as follows: 214 patients identified (189 male, 25 female). Average age was 31.5 years (range 3–80). The majority presented between 20:00 and 05:00. Knives were the commonest weapon. Fifty-two had scalp, 137 face and 69 neck injuries. Forty-eight percent had additional non-head and neck injuries. Eighty-six percent required admission, 16.6% to intensive care. Oral and maxillofacial and plastic surgeons provided most treatment. One hundred two required treatment under general and 96 local anaesthetic. Sixteen patients had significant vascular injury, 1 brachial plexus injury, 4 facial nerve injuries (of which 3 repaired) and one required parotid duct repair. Mean length of stay was 3.7 days. No mortality was recorded. Incidence significantly increased from 2010 to 2019. Conclusions Head and neck penetrating injuries occur frequently, often with other injuries and mainly in young males. Incidence of significant vascular or nerve injury was low. This study provides important data for those planning trauma services.

‘No zone’ approach in the management of penetrating neck injuries – an Australian Tertiary Trauma Centre experience

“…This may be due to relatively lower rates of assault, compared to other countries commonly examining PNIs, such as the USA and South Africa; less firearm‐related violence in Australia; and possibly higher rates of hospitalization for other traumas, such as falls, motor vehicle accidents and sporting incidents. The patient population was predominantly male (82.8%) with a median age of 35, which aligns with data from around the world including the UK, 15,16 Africa, 17–19 Asia 8 and the USA 6,20 . However contrary to US studies where up to 40% of PNI's are due to gunshot wounds, only 8 patients (3.9%) were firearm‐related in our series, which is more in keeping with UK 16 and South African 18 data, likely owing to national laws around firearm possession and use.…”

Use of a Rapid Rhino in haemorrhage control for penetrating neck injury presenting in traumatic cardiac arrest

“…Severe penetrating neck injury is rarely encountered outside major cities 3 and the rural nature of this incident highlights the challenge of managing such patients and the need for enhanced care teams deliverable by air who can provide the necessary care.…”

“…Haemorrhage is the primary cause of death in PNI in 50% of patients, 2 and Foley catheter balloon tamponade (FCBT) has been discussed in the literature as a possible method of haemorrhage control. 3 We present a case highlighting the novel use of a Rapid Rhino™ (Smith and Nephew) epistaxis control device to achieve haemorrhage control in a patient who had lost cardiac output due to a massive haemorrhage from a selfinflicted penetrating neck injury.…”

“…Haemorrhage is the primary cause of death in PNI in 50% of patients, 2 and Foley catheter balloon tamponade (FCBT) has been discussed in the literature as a possible method of haemorrhage control. 3…”

“…Emergency Department, Ysbyty Glan Clwyd, Bodelwyddan, UK2 Emergency Retrieval and Transfer Service Caernarfon, Wales, UK3 Anaesthetic Department, University Hospitals North Midlands, Caernarfon, UK…”