Selective observational management of penetrating neck injury in Northern Nigeria

Abstract

Background. The most appropriate management of penetrating
neck injury (PNI) remains controversial. This study was conducted to determine the accuracy and safety of physical examination as the basis of selective observational management of PNI at our institution.
Methods. The study was conducted between 1991 and 2006. Patients whose injuries penetrated platysma were included. Following resuscitation, physical signs were utilised to select patients for exploration or observation. Investigations were based on physical signs which, with details of injured structures, treatments and outcomes, were recorded.
Results. There were 225 patients of whom 209 (93.0%) were men. Their mean age was 28 years. The majority (74.2%) of cases were stab wounds, and the balance (25.8%) were gunshot injuries. In 37.8% and 27.6% of patients, injuries were sustained during armed civilian conflicts and robberies, respectively. Patients with no signs of significant injuries
(37.8%) were treated by observation. Overall, 52.4% underwent neck exploration; injuries requiring repair were found in 87.3% of these patients. Physical signs as a basis of detecting significant injury had a sensitivity of 97.2% and specificity of 87.4%. Overall mortality was 4.0%.
Conclusion. Physical examination can accurately select patients with PNI who can be safely managed by observation. Physical signs can also identify patients who require further diagnostic evaluations.