Adding insult to injury: neck exploration for penetrating pediatric neck trauma

Abstract

Penetrating neck injuries are uncommon in children, and management involves mandatory exploration of the neck. This results in a number of unnecessary operations. Adult experience is moving towards selective exploration. A retrospective review was performed on all trauma patients presenting over the past 10 years. Pediatric patients with penetrating neck injury were selected and data were collected and analyzed. Out of a total of 19,363 trauma patients over the study period, we identified 39 children with 42 penetrating neck injuries. The average age was 13 years, and 56 per cent of cases were male. A large proportion (72%) was African-American. Over half of the injuries (63%) were from projectiles, including gun shot wounds (59%), which tended to be in the older children, whereas animal bites (5) were noted as a predominant cause in the younger ones. Six patients underwent exploration without any preoperative imaging due to penetration of the platysma, and four of these were nontherapeutic. Eighteen patients with platysma penetration underwent directed preoperative imaging, and 15 avoided operative exploration. CT scans were the most common imaging modality (68%). The median injury severity score was 11. The hospital length of stay was longer in the patients who underwent exploration. Mandatory exploration of the neck in children should not be performed unless clinically indicated. Preoperative imaging should be used liberally to limit nontherapeutic explorations, improve diagnostic accuracy, and reduce morbidity.