A comparison of presenting symptoms and signs to CT-angiogram and contrast swallow in penetrating neck injury

Abstract

Background: Penetrating neck injuries account for a significant trauma burden on the provincial healthcare system. Penetrating neck trauma ranges from obvious aerodigestive and/or vascular injuries with unstable physiology, to stable patients with subtle injuries which may cause morbid complications in the future if overlooked. The majority of the hospitals in the province have major inadequacies in terms of radiology staff and equipment, leading to a significant burden on Inkosi Albert Luthuli Central Hospital (IALCH).

Methods: A retrospective descriptive study was performed using data from the IALCH trauma unit databases, reviewing patient charts between 1 January 2018 and 31 December 2020. Data retrieved encompassed the age, demographics, referral hospitals, mechanism of injury, type of injuries, zones, imaging indications and results.

Results: Patients were referred from surrounding hospitals, the majority of which were young males and the lead mechanism was stab wounds. The vast majority of injuries were found in zone 2 and the majority of patients were referred exclusively due to proximity of skin injury and positive imaging findings formed the minority.

Conclusion: For patients with soft signs of vascular injury there is room for clinical observation without routine imaging. Similarly, patients with soft signs of oesophageal injury, such as proximity, dysphagia, dysphonia, odynophagia, retropharyngeal air on CT and hematemesis may be admitted for observation rather than routinely imaged, provided they can access surgical care if they fail non-operative management.