The Role of Clinical Examination in Excluding Vascular Injury in Haemodynamically Stable Patients with Gunshot Wounds to the Neck. A Prospective Study of 59 Patients

Mohammed, G.S.; Pillay, Woolagasen; Barker, P; Robbs, J V

doi:10.1016/j.ejvs.2004.07.007

Cited by 31 publications

(19 citation statements)

References 31 publications

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“…14,15 In one recent study, only eight zone 3 injuries were reported. 40 Our study is the largest in the literature but still has less than 100 patients. However, two other larger studies reported in the world literature support our recommendations.…”

Section: Discussionmentioning

confidence: 94%

Redefining the Role of Arterial Imaging in the Management of Penetrating Zone 3 Neck Injuries

Ferguson

Dennis

et al. 2005

Vascular

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The purpose of this study was to assess the role of arteriography (AG) in the diagnosis and treatment of vascular trauma in patients with zone 3 penetrating neck injuries. The records of all cases of penetrating neck trauma for the past 14 years at a level 1 trauma center were reviewed retrospectively. Eight hundred forty-four penetrating neck injuries were documented, of which 72 (8.5%) traversed zone 3 of the neck (gunshot, 35; stab, 32; shotgun, 5). Twenty patients (27%) had hard signs of vascular injury (hemorrhage, expanding hematoma, bruit, thrill, neurologic deficit). Twelve of these (60%) underwent immediate exploration, 1 had no significant injury, and 11 had successful surgical repair or ligation of the vascular injury. AG in the other eight patients with hard signs revealed injuries requiring embolization (three patients), urokinase infusion (one patient), and observation (three patients) and one normal examination. Fifty-two patients had no hard signs of vascular injury. Twenty-four of these underwent AG, of which 18 were negative. Positive findings included internal carotid artery narrowings (two patients), external compression of the internal carotid artery (one patient), vertebral artery intimal flap (one patient), and nonbleeding injuries to small, noncritical arteries (two patients), none of which required treatment. Twenty-four of the remaining 28 patients were observed clinically, and 4 patients had negative explorations. Nine patients had ultrasonography performed, but these examinations did not yield any useful information. The absence of hard signs reliably excludes surgically significant vascular injuries in penetrating zone 3 neck trauma, suggesting that AG is not necessary. Hard signs in stable patients should mandate AG because these vascular injuries may be amenable to endovascular therapy.

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Section: Discussionmentioning

confidence: 94%

Redefining the Role of Arterial Imaging in the Management of Penetrating Zone 3 Neck Injuries

Ferguson

Dennis

et al. 2005

Vascular

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“…6,9,11 The other area of controversy in the management of these two groups of patients is the approach to imaging. [6][7][8][9][10]14,[18][19][20][21] Generally, SWs to the neck can be selectively imaged based on a detailed clinical assessment although the advent of CTA has increased the reliance of clinicians on imaging as it is non-invasive and can performed rapidly without the need for arterial cannulation. A number of authors advocate selective imaging based on clinical assessment.…”

Section: Discussionmentioning

confidence: 99%

“…7,10,21 However, many of these studies reported predominantly on SWs to the neck and most authors advocate mandatory imaging for GSWs to the neck although there are notable dissenters to this approach. 6,[18][19][20] In a study from our parent institution published in 2004, 59 GSWs were reviewed and it was concluded that the assessment of patients with GSWs by physical examination alone is very difficult. 20 The authors were especially concerned about injuries to zones 1 and 3, and their results demonstrated that physical examination alone would miss a significant number of injuries.…”

Section: Discussionmentioning

confidence: 99%

A comparative audit of gunshot wounds and stab wounds to the neck in a South African metropolitan trauma service

Madsen

Laing

Bruce

et al. 2016

annals

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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 There were 452 SW and 58 GSW cases over the 46 months of the study. Patients with GSWs were more likely to have extracervical injuries than those with SWs (69% vs 63%). The incidence of a 'significant cervical injury' was almost twice as high in the GSW cohort (55% vs 31%). For patients with transcervical GSWs, this increased to 80%. The mean ISS was 17 for GSW and 11 for SW patients. Those in the GSW cohort presented with threatened airways and a requirement for an emergency airway three times as often as patients with SWs (24% vs 7% and 14% vs 5% respectively). The incidence among GSW and SW patients respectively was 5% and 6% for airway injuries, 12% and 8% for injuries to the digestive tract, 21% and 16% for vascular injuries, 59% and 10% for associated cervical injuries, 36% and 14% for maxillofacial injuries, 16% and 9% for injuries to the head, and 35% and 45% for injuries to the chest. In the GSW group, 91% underwent computed tomography angiography (CTA), with 23% of these being positive for a vascular injury. For SWs, 74% of patients underwent CTA, with 17% positive for a vascular injury. Slightly more patients with GSWs required operative intervention than those with SWs (29% vs 26%). Conclusions Patients with GSWs to the neck have a worse outcome than those with injuries secondary to SWs. However, the proportion of neck injuries actually requiring direct surgical intervention is not increased and most cases with PNI secondary to GSWs can be managed conservatively with a good outcome. Imaging should be performed for all GSWs to the neck.

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“…Shock waves, usually created by high-velocity missiles also indirectly affect the vessels in the region causing vessel thrombosis, embolism and pseudoaneurysm [22]. Physical examination is not very valuable in the assessment of shotgun-related vascular injuries to the head and neck [24].…”

Section: Discussionmentioning

confidence: 99%

Dissecting firearm injury to the head and neck with non-linear bullet trajectory: A case report

Can

Yildirim

Ataç

2010

Forensic Science International

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The Role of Clinical Examination in Excluding Vascular Injury in Haemodynamically Stable Patients with Gunshot Wounds to the Neck. A Prospective Study of 59 Patients

Cited by 31 publications

References 31 publications

Redefining the Role of Arterial Imaging in the Management of Penetrating Zone 3 Neck Injuries

Redefining the Role of Arterial Imaging in the Management of Penetrating Zone 3 Neck Injuries

A comparative audit of gunshot wounds and stab wounds to the neck in a South African metropolitan trauma service

Dissecting firearm injury to the head and neck with non-linear bullet trajectory: A case report

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