Computed tomography in the evaluation of penetrating neck trauma - A preliminary study

Hypothesis: Penetrating neck trauma has traditionally been evaluated by sur gical exploration and/or invasive diagnostic studies. We hypothesized that computed tomography (CT), used as an early diagnostic tool to accurately de termine trajectory, would direct or eliminate further studies or procedures in stable patients with penetrating neck trauma. Design: Retrospective case series. Setting: Academic, urban, level I trauma center. Patients: Hemodynamically stable patients without hard signs of vascular in jury or aerodigestive violation who had sustained penetrating trauma to the neck. Interventions: Patients underwent a spiral CT as an initial diagnostic stud y after initial evaluation in the trauma bay. Further invasive studies were directed by CT findings. Main Outcome Measures: Number of invasive studies performed. Results: Twenty-three patients were identified during the 30-month period. Nineteen patients sustained gunshot wounds; 3, shotgun wounds; and 1, a sta b wound. One patient died of a cranial gunshot wound. Three isolated zone 1 , 1 isolated zone II, 9 isolated zone III, and 10 multiple neck zone trajec tories were evaluated. Thirteen patients were identified by CT to have traj ectories remote from vital structures and required no further evaluation. T en patients underwent angiography. Only 2 underwent bronchoscopy and esopha goscopy. Four patients were discharged from the emergency department; 7 oth er patients were discharged within 24 hours. No adverse patient events occu rred before, during, or after CT scan. Conclusions: Computed tomography in stable selected patients with penetrati ng neck trauma appears safe. Invasive studies can often be eliminated from the diagnostic algorithm when CT demonstrates trajectories remote from vita l structures. As a result, efficient evaluation and early discharge from th e trauma bay or emergency department can be realized. Further prospective s tudy of CT scan after penetrating neck trauma is needed.