medigraphic.com
ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2000, Number 1

<< Back Next >>

An Med Asoc Med Hosp ABC 2000; 45 (1)

Penetrating neck trauma: Is physical examination reliable in the diagnosis of lesions?

Flores J, Ortiz PJ, Cervantes J

Language: Spanish
References: 17
Page: 6-12
PDF size: 171.29 Kb.


ABSTRACT

Background: In the last years, the management of penetrating neck trauma has become controversial. Historically all of these injuries were explored; therefore there was a high frequency of negative surgical explorations. In the last 5 years, numerous reports have supported the selective management of these injuries with low morbidity and mortality. Objective: To determine the usefulness of the physical examination in the management of penetrating neck injuries. Material and methods: A prospective, longitudinal and descriptive study was done in the University del Valle Hospital “Evaristo García”, in Santiago de Cali, Colombia for the period of July to August of 1999. Forty patients with penetrating neck injuries were included. All patients underwent physical examination, focusing in signs and symptoms suggesting injuries in the esophageal tract, superior airway, vascular and neurologic system. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the physical examination were evaluated. Results: The sensitivity and specificity of the physical examination for the diagnosis of vascular injury was 80% and 72% respectively, with a PPV 33% and a NPV 75%. The sensitivity for the esophagic injury was 100% and a specificity of 30%, a PPV 22%, and a NPV of 100%. For the injuries of the airway, the physical examination had a sensitivity of 100%, specificity of 40%, PPV 40% and a NPV of 100%. Conclusion: The physical examination is highly sensitive in diagnosing injuries in the airway, digestive tract and vascular system in the penetrating neck trauma. The clinical evaluation is still indispensable for detecting in time injuries that have not been observed in the initial evaluation.


REFERENCES

  1. Kendall JL, Anglin D, Demetriades D. Contemporary issues in trauma. Penetrating neck trauma. Emergency Medicine. Clin N Am 1998; 16: 85-105.

  2. Rodríguez A, Ferrada R (eds). Trauma. Sociedad Panamericana de Trauma. Cali, Colombia: Ed Feriva, 1997; 239-253, 559-568.

  3. Schwartz S, Shires T, Spencer F (eds). Principios de Cirugía. Traumatismos. Vol 1. México: Interamericana. 1991: 187-245.

  4. Demetriades D, Asensio JA, Velmahos G, Thal E. Complex and challenging problems in trauma surgery. Surg Clin N Am 1996; 76: 661-683.

  5. Demetraides D, Theodorou D, Cornweil E, Berne TV, Asensio JA et al. Evaluation of penetrating injuries of the neck. Study prospective of 223 patients. World J Surg 1997; 21: 41-48.

  6. Apffelstaedt J, Muller R. Results of mandatory exploration for penetrating neck trauma. World J Surg 1994; 18: 917-920.

  7. Ngakane H, Muckart DJ, Luvuno F. Penetrating visceral injuries of the neck: results of a conservative management policy. Br J Surg 1990; 77: 908-910.

  8. Beitsch P, Weigelt J, Flynn E, Easley S. Physical examination and arteriography in patients with penetrating zone II neck wounds. Arch Surg 1994; 129: 577-581.

  9. Rao P, Rao I, Sharma P, Vinzons AT, Nassoura Z, Stahi W. Cervical vascular injuries: A trauma center experience. Surgery 1993; 114: 527-531.

  10. Frykberg E, Vines F, Alexander R. The natural history of clinically occult arterial injuries: A prospective evaluation. J Trauma 1989; 29: 577-583.

  11. Stain S, Yellin A, Weaver FA, Pentecost MJ. Selective management of nonoclussive arterial injuries. Arch Surg 1989; 124: 1136-1140.

  12. Obeid F, Haddad G, Horst HM, Bivins B. A critical reappraisal of mandatory exploration policy for penetrating wounds of the neck. Surg Gynecol Obstet 1985; 160: 517-522.

  13. Demetriades D, Charalambides D, Lakhoo M. Physical examination and selective conservative management in patients with penetrating injuries of the neck. Br J Surg 1993; 80: 1534-1536.

  14. Meyer J, Barret J, Schuier JJ, Flanigan DP. Mandatory vs selective exploration for penetrating neck trauma. A prospective assessment. Arch Surg 1987; 122: 592-597.

  15. Stone H, Callahan S. Soft tissue Injuries of the neck. Surg Gynecol Obstet 1963; 117: 745-752.

  16. Armstrong W, Detar T, Stanley R. Diagnosis and management of external penetrating cervical esophageal injuries. Ann Otol Rhinol Laryngol 1994; 103: 863-871.

  17. Cheadle W, Richardson D. Options in management of trauma to the esophagus. Surg Gynecol Obstet 1982; 155: 380-384.




2020     |     www.medigraphic.com