Abstract:Introduction The aim of this comparative study of gunshot wounds (GSWs) and stab wounds (SWs) to the neck was to quantify the impact of the mechanism of injury on the outcome and management of penetrating neck injury (PNI). Methods A prospective trauma registry was interrogated retrospectively. Data were analysed pertaining to demographics and injury severity score (ISS), physiology on presentation, anatomical site of wounds and injuries sustained, investigations, management, outcome and complications. Results… Show more
“…The numbers treated here are also well below those seen in some centres internationally. For example, a study in a trauma centre in Pietermaritzburg, South Africa, recorded 462 neck stab wounds in 46 months, with a mortality of 2% [ 12 ]. An analysis of 13 years’ data from a trauma centre in Los Angeles, USA, recorded 606 PNIs [ 13 ].…”
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.
“…The numbers treated here are also well below those seen in some centres internationally. For example, a study in a trauma centre in Pietermaritzburg, South Africa, recorded 462 neck stab wounds in 46 months, with a mortality of 2% [ 12 ]. An analysis of 13 years’ data from a trauma centre in Los Angeles, USA, recorded 606 PNIs [ 13 ].…”
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.
“…This decision making is intimately related to both the zone of injury in the neck (Table 2) and the mechanism of injury as gunshot wounds (GSWs) are far more destructive than SWs and some authors will routinely image all GSWs to the neck. 11…”
Section: Resuscitationmentioning
confidence: 99%
“…2,9 In one study of 510 PNI patients, 76% underwent CTA and if CTA did not show an injury then it could be safely concluded that there was no injury. There is however a definite risk of a false positive results and this must be borne in mind when planning management of an injury seen on CTA; 11 the use of CTA as a screening modality for asymptomatic patients is probably not justified. 21,22 Figure 2.(a) Filling defect in the proximal segment of the right common carotid artery, zone 1 and (b) pseudoaneurysm of the right common carotid artery, zone 2.…”
Penetrating neck injuries are serious as there is a high concentration of vital structures in close proximity to each other in a compressed anatomical area. Penetrating neck injuries can be immediately life threatening due to massive bleeding from vascular structures or due to airway compromise. Injury to the digestive tract in the neck may also result in delayed and potentially life-threatening conditions. The majority (79%) of penetrating neck injuries can be managed conservatively. The clinician caring for such a patient requires a structured and comprehensive approach to managing these injuries. This article will provide a general overview of penetrating neck injuries, including resuscitation, epidemiology, surgical management and the use of appropriate imaging.
“…The absence of management guidelines for pharyngoesophageal injuries is due to the paucity of available literature, particularly in regard to operative intervention. Most recommendations originate from studies on penetrating neck trauma (6–8, 14–16). In a review of eight studies with 179 patients that included penetrating, blunt, and iatrogenic injuries, 105 underwent surgical management and the remaining 74 were observed.…”
Pharyngoesophageal injuries are rare following blunt trauma. Only a quarter require a neck exploration and this decision appears to be dictated by the injury burden. Selective non-operative management based on clinical status seems to be feasible and is not associated with increased mortality.
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