Can computed tomographic angiography accurately exclude digestive tract injury after penetrating cervical trauma?

Abstract

Background: Multislice computed tomographic angiography (MCTA) has become the method of choice to screen for arterial injury in penetrating cervical  trauma (PCT). There is, however, limited knowledge on its accuracy in terms of digestive tract injury (DTI). Currently, our unit liberally employs  both computed tomographic angiography (CTA) and contrast swallow for platysma breaching penetrating neck injuries. This study aimed to determine  the accuracy of specific computed tomography findings in the diagnosis of DTI after PCT.

Methods: This was a retrospective review of all consecutive patients with PCT who had undergone MCTA that presented at a single, tertiary, high-volume  trauma centre from January 2013 until December 2015. Blinded radiological review of 140 MCTA investigations (33 in the injury group and 107 in the  control group) was performed in order to calculate the diagnostic accuracy of trajectory, air, and conventional MCTA signs in the diagnosis of DTI after  PCT.

Results: Over the study period, 906 patients presenting with PCT had undergone MCTA and a total of 33 patients (3.6%) had confirmed DTI on  aggregate gold standard of diagnosis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MCTA for detecting DTI  was 100%, 65.4%, 47.1%, and 100%, respectively. No injuries were missed on MCTA.

Conclusion: Our findings suggest that DTI can be safely excluded by  means of careful assessment of specific signs on CTA in patients presenting after PCT, obviating the need for further investigation.