Abstract：
BACKGROUND: Management of penetrating neck injuries (PNIs) has evolved over time, more frequently relying on increased utilization of diagnostic imaging studies. Directed work-up with computed tomography imaging has resulted in increased use of angiography and decreased operative interventions. We sought to evaluate management strategies after directed work-up, hypothesizing increased use of non-operative therapeutic interventions and lower mortality after directed work-up.
METHODS: Patients with PNI from 2017 to 2022 were identified from a single-center trauma registry. Demographics, injuries, physical exam findings, diagnostic studies and interventions were collected. Patients were stratified by presence of hard signs and management strategy [directed work-up (DW) and immediate operative intervention (OR)] and compared. Outcomes included therapeutic non-operative intervention [endovascular stent, embolization, dual antiplatelet therapy (DAPT), or anticoagulation (AC)], non-therapeutic neck exploration, length of stay (LOS), and mortality.
RESULTS: Of 436 patients with PNI, 143 (33%) patients had vascular and/or aerodigestive injuries. Of these, 115 (80%) patients underwent DW and 28 (20%) patients underwent OR. There were no differences in demographics or injury severity score between groups. Patients in the DW group were more likely to undergo vascular stent or embolization (p = 0.040) and had fewer non-therapeutic neck explorations (p = 0.0009), compared to the OR group. There were no differences in post-intervention stroke, leak, or mortality. Sixty percent of patients with vascular hard signs and 78% of patients with aerodigestive hard signs underwent DW.
CONCLUSIONS: Directed work-up in select patients with PNI is associated with fewer non-therapeutic neck explorations. There was no difference in mortality. Selective use of endovascular management, AC and DAPT is safe.
METHODS: Patients with PNI from 2017 to 2022 were identified from a single-center trauma registry. Demographics, injuries, physical exam findings, diagnostic studies and interventions were collected. Patients were stratified by presence of hard signs and management strategy [directed work-up (DW) and immediate operative intervention (OR)] and compared. Outcomes included therapeutic non-operative intervention [endovascular stent, embolization, dual antiplatelet therapy (DAPT), or anticoagulation (AC)], non-therapeutic neck exploration, length of stay (LOS), and mortality.
RESULTS: Of 436 patients with PNI, 143 (33%) patients had vascular and/or aerodigestive injuries. Of these, 115 (80%) patients underwent DW and 28 (20%) patients underwent OR. There were no differences in demographics or injury severity score between groups. Patients in the DW group were more likely to undergo vascular stent or embolization (p = 0.040) and had fewer non-therapeutic neck explorations (p = 0.0009), compared to the OR group. There were no differences in post-intervention stroke, leak, or mortality. Sixty percent of patients with vascular hard signs and 78% of patients with aerodigestive hard signs underwent DW.
CONCLUSIONS: Directed work-up in select patients with PNI is associated with fewer non-therapeutic neck explorations. There was no difference in mortality. Selective use of endovascular management, AC and DAPT is safe.
摘要：
背景：穿透性颈部损伤（PNI）的管理随着时间的推移而发展，更频繁地依赖于诊断成像研究的增加利用。计算机断层扫描成像的定向检查导致血管造影的使用增加和手术干预的减少。我们试图在定向工作后评估管理策略，假设非手术治疗干预措施的使用增加,定向检查后死亡率降低.
方法：2017年至2022年的PNI患者从单中心创伤登记中确定。人口统计,受伤,体检结果,收集诊断研究和干预措施.根据硬体征和管理策略[指导检查（DW）和立即手术干预（OR）]对患者进行分层并进行比较。结果包括治疗性非手术干预[血管内支架，栓塞,双重抗血小板治疗（DAPT），或抗凝（AC）]，非治疗性颈部探查术，停留时间(LOS)和死亡率。
结果：在436例PNI患者中，143例（33%）患者有血管和/或呼吸性损伤。其中,115例（80％）患者接受DW，28例（20％）患者接受OR。两组之间的人口统计学或损伤严重程度评分没有差异。DW组患者更有可能接受血管支架或栓塞（p=0.040），而非治疗性颈部探查较少（p=0.0009），与OR组相比。干预后卒中没有差异，泄漏,或死亡率。60％的血管硬体征患者和78％的呼吸消化硬体征患者接受了DW。
结论：部分PNI患者的定向检查与较少的非治疗性颈部探查相关。死亡率没有差异。选择性使用血管内治疗，AC和DAPT是安全的。
方法：2017年至2022年的PNI患者从单中心创伤登记中确定。人口统计,受伤,体检结果,收集诊断研究和干预措施.根据硬体征和管理策略[指导检查（DW）和立即手术干预（OR）]对患者进行分层并进行比较。结果包括治疗性非手术干预[血管内支架，栓塞,双重抗血小板治疗（DAPT），或抗凝（AC）]，非治疗性颈部探查术，停留时间(LOS)和死亡率。
结果：在436例PNI患者中，143例（33%）患者有血管和/或呼吸性损伤。其中,115例（80％）患者接受DW，28例（20％）患者接受OR。两组之间的人口统计学或损伤严重程度评分没有差异。DW组患者更有可能接受血管支架或栓塞（p=0.040），而非治疗性颈部探查较少（p=0.0009），与OR组相比。干预后卒中没有差异，泄漏,或死亡率。60％的血管硬体征患者和78％的呼吸消化硬体征患者接受了DW。
结论：部分PNI患者的定向检查与较少的非治疗性颈部探查相关。死亡率没有差异。选择性使用血管内治疗，AC和DAPT是安全的。
