PENETRATING INJURIES OF THE NECK IN PATIENTS IN STABLE CONDITION - PHYSICAL-EXAMINATION, ANGIOGRAPHY, OR COLOR-FLOW DOPPLER IMAGING

Background: The initial assessment of penetrating injuries of the neck is controversial, with angiography re; maining the gold standard for identifying vascular injuries. Recent reports suggest that physical ex amination might be an accurate way to evaluate these injuries. Color f low Doppler imaging has been used with promising results to assess ext remity injuries, but the role of color flow Doppler imaging in neck in juries has not been studied. Objective: To evaluate and compare the ro les of physical examination, color flow Doppler imaging, and angiograp hy in the identification and management of penetrating neck injuries. Study Design: A prospective study of patients in stable condition with penetrating injuries of the neck. All study patients were examined ac cording to a written clinical protocol and subsequently underwent angi ography and color flow Doppler imaging. The sensitivity and specificit y of physical examination and color flow Doppler imaging were compared -with those of angiography. Results: Eighty-two patients fulfilled the criteria for inclusion in the study. Angiography demonstrated vascula r lesions in 11 patients (13.4%),but only two (2.4%) of them required treatment. Serious injuries were detected or suspected during physical examination, but six lesions not requiring treatment were missed. Whe n injuries not requiring treatment were excluded, the sensitivity was 100% and the specificity was 91%. With color flow Doppler imaging, 10 of the 11 injuries were identified, for a sensitivity of 91% and a spe cificity of 98.6%. The sensitivity and specificity were 100% for clini cally important lesions. Conclusion: The combination of a careful phys ical examination and color flow Doppler imaging provides a reliable wa y to assess penetrating neck trauma and may be a safe alternative to r outine contrast angiography.