Background: The Western Trauma Association (WTA) describes the management of Zone 2 penetrating neck trauma (PNT) and recommends neck exploration (NE) for patients with clinical hard signs (HS). We hypothesize that in stable patients with HS, the management of PNT augmented by computed tomography angiography (CTA) results in fewer negative NE results.
Methods: This was a 4-year retrospective review of adult patients with Zone 2 PNT at a Level I trauma center. Stable patients with WTA-defined HS (airway compromise, massive subcutaneous emphysema/air bubbling through wound, expanding/pulsatile hematoma, active bleeding, shock, focal neurologic deficit, and hematemesis) who underwent CTA instead of emergent exploration were identified. Sensitivity, specificity, positive predictive value, and negative predictive value for CTA were calculated. A comparison was made between the rates of negative NE results in patients with HS who received a CTA versus the rate that would have occurred in the same patients if the WTA algorithm had been followed. Missed injury rates were also compared.
Results: Of 183 PNT patients, 23 had HS and underwent CTA. Of the 23, 5 had a positive CTA findings and underwent NE, while 17 had a negative CTA findings and did not require NE. There was one false-negative in a patient who developed an expanding hematoma following negative neck CTA finding. Sensitivity, specificity, positive predictive value, and negative predictive value for CTA in the presence of HS were found to be 83%, 100%, 100%, and 94%, respectively. The addition of CTA to the WTA algorithm for this patient group significantly decreased the rate of negative NE (0 of 23 vs. 18 of 23, p < 0.001) without a significant increase in the rate of missed injury (1 of 23 vs. 0 of 23, p = 0.323). The use of CTA prevented 17 unnecessary NEs.
Conclusion: CTA addition to the management of hemodynamically stable patients with HS in PNT significantly decreased the rate of negative NE result without increasing missed injury rate. Prospective study of CTA addition to the WTA algorithm is needed.
Level Of Evidence: Care management/therapeutic study, level IV.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/TA.0000000000000713 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Aberrant anatomical variation of the vertebral artery (VA) from an internal carotid artery (ICA) is considered a rare finding. The incidence of this phenomenon can lead to patients suffering from posterior circulation neurological deficit if the ICA becomes significantly diseased. VA atypical anatomical origin is considered one of the rare pathologies, not only precipitating neurovascular incidents but equally leading to severe difficulty in VA dissection and surgical exposure, especially in carotid artery procedures.
View Article and Find Full Text PDFClinical Insights on My Acute Ischemic Stroke Caused by a Carotid Web.
Cureus
December 2024
Department of Pediatrics, Japanese Red Cross Wakayama Medical Center, Wakayama, JPN.
Acute ischemic stroke, a medical emergency caused by reduced cerebral blood flow, results in brain cell damage. While commonly associated with older individuals, strokes can also occur in young and middle-aged adults, posing significant socio-economic and health challenges due to the long-term impact of the condition. This poses significant socio-economic and health challenges because stroke is a leading cause of disability and mortality.
View Article and Find Full Text PDFA cross-sectional study on the correlation between internal cerebral vein asymmetry and hemorrhagic transformation following endovascular thrombectomy.
Front Neurol
January 2025
Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China.
Introduction: Hemorrhagic transformation (HT) is a severe complication in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) after endovascular treatment (EVT). We hypothesize that asymmetry of the internal cerebral veins (ICVs) on baseline CT angiogram (CTA) may serve as an adjunctive predictor of HT.
Methods: We conducted a study on consecutive AIS-LVO patients from November 2020 to April 2022.
Optimized contrast enhancement and homogeneity in aortic CT angiography: bolus tracking with personalized post-trigger delay.
Quant Imaging Med Surg
January 2025
Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Background: The bolus tracking technique has been used for decades, yet still faces the challenging task of determining the optimal scanning time for individuals. Our study aimed to assess the feasibility of a novel bolus tracking method with a personalized post-trigger delay (PTD) to optimize scanning time and achieve optimized enhancement and contrast homogeneity in aortic computed tomography angiography (CTA).
Methods: Participants undergoing aortic CTA with bolus tracking were prospectively assigned to two different groups: Group A with a fixed 6-second PTD and Group B with a personalized PTD.
Effect of different scanning threshold triggers on the image quality of brain computed tomography angiography: a randomized controlled trial.
Quant Imaging Med Surg
January 2025
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Background: The scanning trigger threshold affects image quality. The aim of this study was to investigate the effect of different scanning trigger thresholds on brain computed tomography angiography (CTA) image quality.
Methods: In this prospective study, 80 patients undergoing brain CTA examinations with dual-layer CT (DLCT) were randomly divided into group A and group B, with 40 patients in each group.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!