Selective surgical management in penetrating neck injuries

Abstract

Objective: To evaluate selective operative management in penetrating neck trauma.

Design: A chart review.

Setting: A university-affiliated hospital in Johannesburg, South Africa.

Patients: All adults admitted to the hospital between January 1988 and June 1993 with a penetrating neck wound. Excluded were patients in whom there was no suspicion of an occult injury that might need further investigation. There were 755 patients in the study.

Interventions: Immediate surgical exploration (group A, 613 patients) and observation with constant monitoring (group B, 142 patients).

Main outcome measures: Unnecessary explorations in group A and missed significant injuries in group B.

Results: In group A there was a 3% incidence of unnecessary explorations, and 4.2% of the patients died. In group B there was a 9.1% incidence of missed injuries, and 2.8% of the patients died as a result of the delayed diagnosis. Overall the death rate was 4%.

Conclusion: Selective operative intervention for penetrating neck trauma results in fewer negative explorations and a death rate comparable to those of series that support mandatory neck exploration.