EVALUATION OF PENETRATING INJURIES OF THE NECK - PROSPECTIVE-STUDY OF223 PATIENTS

The objective of this study was to assess the role of clinical examina tion, angiography, color flow Doppler imaging, and other diagnostic te sts in identifying injuries to the vascular or aerodigestive structure s in patients with penetrating injuries to the neck. A prospective stu dy was made of patients with penetrating neck injuries. All patients h ad a careful physical examination according to a written protocol, Sta ble patients underwent routine four-vessel angiography and color flow Doppler imaging. Esophagography and endoscopy were performed for proxi mity injuries. The sensitivity, specificity, and predictive values of physical examination, color flow Doppler studies, and other diagnostic tests were assessed during the evaluation of vascular and aerodigesti ve tract structures in the neck Altogether 223 patients were entered i n the study, After physical examination 176 patients underwent angiogr aphy and 99 of them underwent color Bow Doppler imaging. Angiographic abnormalities were seen in 34 patients for an incidence of 19.3%, but only 14 (8.0%) required treatment. Color Bow Doppler imaging was perfo rmed on 99 patients with a sensitivity of 91.7%, specificity 100%, pos itive predictive value (PPV) 100%, and negative predictive value (NPV) 99%, These values were all 100% when only injuries requiring treatmen t were considered. None of the 160 patients without clinical signs of vascular injury had serious vascular trauma requiring treatment (NPV 1 00%), although angiography in 127 showed II vascular lesions not requi ring treatment. ''Hard'' signs on clinical examination (large expandin g hematomas, severe active bleeding, shock not responding to fluids, d iminished radial pulse, bruit) reliably predicted major vascular traum a requiring treatment, Among 34 of the 223 total patients (15.2%) admi tted with ''soft'' signs, 8 had angiographically detected injuries, bu t only one required treatment, An esophagogram was performed on 98 pat ients because of proximity injuries (49 patients) or suspicious clinic al signs (49 patients), and two of them showed esophageal perforations , None of the 167 patients without clinical signs of esophageal trauma had an esophageal injury requiring treatment. It was concluded that p hysical examination is reliable for identifying those patients with pe netrating injuries of the neck who require vascular or esophageal diag nostic studies, Color flow Doppler imaging is a dependable alternative to angiography. An algorithm for the initial assessment of neck injur ies is suggested.