Citation

Ibraheem K, Wong S, Smith A, Guidry C, McGrew P, McGinness C, Duchesne J, Taghavi S, Harris C, Schroll R. J. Trauma Acute Care Surg. 2020; ePub(ePub): ePub.

Copyright

(Copyright © 2020, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002919

PMID

32890346

Abstract

BACKGROUND: Penetrating neck trauma continues to present a diagnostic dilemma. Practice guidelines advocate the use of computed tomography angiography (CTA) for suspected vascular or aero-digestive injuries in all neck zones. There is also an evolving evidence of 'No Zone' approach where the decision to obtain a CTA is guided by physical exam findings and clinical presentation. The aim of this systematic review is to examine existing literature on the diagnostic accuracy of CTA as an integral component of the "no zone" approach in stable patients witt penetrating neck trauma.

METHODS: We performed a systematic review using an electronic search of three databases (PubMed, Medline, Cochrane Review) from 2000-2017.

RESULTS: A total of 5 prospective and 8 retrospective studies were included. The sensitivity of CTA ranged from 83-100%; specificity, 61-100%; positive predictive value, 30-100% and negative predictive value, 90-100%. Three studies reported high sensitivity and specificity for the detection of vascular injuries, but low specificity for aero-digestive tract injuries. When stratified by clinical presentation, CTA had a sensitivity of 89.5-100% and specificity of 61-100% in stable patients presenting with soft signs. In a combined group of stable patients with either hard signs or soft signs, the sensitivity of CTA was 94.4-100% and specificity 96.7-100%. Among patients presenting with hard signs, the sensitivity of CTA was 78.6-90% and specificity is 100%.

CONCLUSIONS: This is the first systematic review to examine the role of computed tomography angiography in penetrating neck trauma. In combination with physical exam, CTA demonstrated a reliable high sensitivity and specificity for detecting injuries in penetrating neck trauma in stable patients with soft signs of injury and select patients with hard signs of injury. These results support the management of penetrating neck trauma using "no zone" approach based on physical examination and the use of CTA in stable patients.

LEVEL OF EVIDENCE: Systematic Review, level IV.

Language: en