Pre-hospital management of penetrating neck injuries: a scoping review of current evidence and guidance

Abstract

Penetrating injuries to the neck pose a unique challenge to clinicians due to the proximity of multiple significant anatomical structures with little protective soft tissue coverage. Injuries to this area, whilst low in incidence, are potentially devastating. Respiratory, vascular, gastro-oesophageal and neurological structures may all be involved, either in isolation or combination. These injuries are particularly difficult to manage in the resource poor, often austere and/or remote, pre-hospital environment. A systematic scoping review of the literature was conducted to evaluate the current available research pertaining to managing this injury profile, prior to the patient arriving in the emergency department. The available research is discussed in sections based on the commonly used trauma management acronym ‘cABCD’ (catastrophic haemorrhage, Airway, Breathing, Circulation, Disability) to facilitate a systematic approach and clinical evaluation familiar to clinicians. Based on the available reviewed evidence, we have proposed a management algorithm for this cohort of patients. From this we plan to instigate a Delphi process to develop a consensus statement on the pre-hospital management of this challenging presentation.

An Unusual Cervical Penetrating Wound Extended to the Right Pleural Dome

“…Sanju et al in Toronto in Canada had recorded delays of four (04) days [13], Adeyi et al in Nigeria had had cases arriving in consultation after twelve (12) hours to four (04) days after the suicide attempt [15]. There is a contrast between lesion severity and mortality [1] [25]. Among the psychotic disorders of young subjects, the risk of suicide is always present in a depressive phase [7] [20].…”

“…Above all, it poses a problem of lesion diagnosis and therapeutic attitude. Their potential seriousness makes them a concern for the ENT surgeon [1]. For Misiak et al in Poland in 2016, the knife blade retained in the neck can at the same time play the role of local hemostasis [25].…”

“…The neck has a complex anatomy made up of blood vessels, aerodigestive and respiratory tracts, nerves, vertebrae, and spinal cord [1]. The solution of continuity of the tissues of the neck with the invasion of the platysma muscle is called penetrating cervical wound [2].…”

Pediatric Penetrating Neck Trauma Resulting From a Metal Boat Cleat: A Case Report

“…Neck injuries can be devastating because the neck contains critical structures in a compact and unprotected anatomic space, particularly in children (Wang et al, 2019). Overall mortality rates have been estimated at 3%–6%, with 50% of deaths due to massive hemorrhage from injury to blood vessels (Mahmoodie et al, 2012; Simpson et al, 2021; Stone et al, 2016). These injuries present a significant diagnostic and therapeutic challenge for the treating physician.…”

The use of Foley catheter tamponade for bleeding control in penetrating injuries

“…With great interest, we have read the review article of Simpson et al [ 1 ] on the current evidence and recommendations for the pre-hospital management of penetrating neck injuries (PNI). We would like to comment on the use of Foley catheters to achieve bleeding control from non-compressible penetrating injuries.…”