Penetrating neck injuries: analysis of experience from a Canadian trauma centre

Objective: To study the demographics and treatment outcome of penetrating n eck injuries presenting to a major trauma centre in order to develop a trea tment protocol. Design: A case review. Setting: A trauma centre at a tertia n care institution. Patients: One hundred and thirty consecutive patients w ho had 134 neck wounds penetrating the platysma and presented to the trauma service between 1979 and 1997. Intervention: Surgical exploration or obser vation alone. Main outcome measures: The location of injury, patient manage ment, number of significant injuries, duration of hospital stay and outcome . Results: Injuries were caused by stab wounds in 124 patients (95%) and gu nshot wounds in 6 (5%). The location of injury was zone I (lower neck) in 2 0 cases (15%), zone II (midportion of the neck) in 108 (81%) and zone III ( upper neck) in 5 (4%). The location was not recorded in 1 case. Fifty: pati ents were managed by observation alone and 80 were managed surgically. Neck exploration in 48 asymptomatic patients was negative in 32 (67%). Signific ant injuries, including major vascular (12), nerve (13) and aerodigestive t ract (19) injuries, were identified in 34 patients. Two of the 130 patients (1.5%) died of major vascular injuries. Seventy-six percent of significant injuries, including all zone II major vascular injuries, were symptomatic on presentation. The mean (and standard deviation) hospital stay for asympt omatic patients treated with observation alone and surgical exploration was similar (3.5 [6.02] versus 4.3 [5.46] days respectively, p = 0.575). Long- term disability, all neurologic in nature, was documented in 3 patients man aged by observation alone and 6 patients managed by surgical exploration. C onclusions: penetrating neck trauma, in particular stab wounds to zone II i n asymptomatic patients, is associated with low morbidity and mortality. A selective management protocol with investigations directed by symptoms is t he most appropriate approach for the patient population and resource base i n this setting.