PENETRATING AND BLUNT NECK TRAUMA - 10-YEAR REVIEW OF A CANADIAN EXPERIENCE

OBJECTIVES: To determine if selective management of blunt and penetrat ing neck trauma is still appropriate in Canadian tertiary care centres because of differences in trauma demographics. a key secondary object ive was a descriptive analysis of the Canadian head and neck trauma pa tient population and outcomes. DESIGN: A retrospective case series. SE TTING: An academic tertiary care centre. PATIENTS: All 85 patients adm itted between 1982 and 1992 with a diagnosis of blunt (19) or penetrat ing (66) neck trauma. INTERVENTIONS: Emergent neck explorations (29 pa tients), selective nonoperative management (20 patients) and elective neck exploration (17 patients). MAIN OUTCOME MEASURES: Hospital stay, complication rate, rate of negative exploration (elective management, emergent exploration) and rate of secondary exploration (selective man agement), and outcome and complication rate. The entire population was described demographically. RESULTS: In 66 patients the injuries were penetrating, with the majority being of low kinetic energy. The patien ts who underwent elective mandatory exploration were comparable to tho se who underwent selective nonoperative management. The length of stay in hospital for the selective group was significantly less (p = 0.000 8), and no patient in this group required later operative management o f a missed injury. However, 41% of patients who underwent elective man datory neck exploration had no significant injury. The complication ra te in the two groups was similar. CONCLUSIONS: The patients managed se lectively had no difference in outcome from those who underwent mandat ory elective exploration. In Canada, because of the lower incidence of high-morbidity zone I and zone III injuries and the high incidence of low kinetic energy trauma with a predilection to zone II, the surgeon may consider a selective approach where appropriate.