Background
Foley catheter balloon tamponade (FCBT) for bleeding penetrating neck injuries (PNIs) is effective. This study aims to audit the technique and outcomes of FCBT.
Methods
Adult patients with ...PNIs requiring FCBT presenting to Groote Schuur Hospital (GSH) within a 22-month study period were prospectively captured on an approved electronic registry. Retrospective analysis included demographics, major injuries, investigations, management and outcomes.
Results
During the study period, 628 patients with PNI were treated at GSH. In 95 patients (15.2%), FCBT was utilised. The majority were men (98%) with an average age of 27.9 years. Most injuries were caused by stab wounds (90.5%). The majority of catheters (81.1%) were inserted prior to arrival at GSH. Computerised tomographic angiography (CTA) was done in 92.6% of patients, while eight patients (8.4%) required catheter-directed angiography. Six were performed for interventional endovascular management. Thirty-four arterial injuries were identified in 29 patients. Ongoing bleeding was noted in three patients, equating to a 97% success rate for haemorrhage control. Thirteen (13.7%) patients required neck exploration. Seventy-two (75.8%) patients without major arterial injury had removal of the catheter at 48–72 h. Two of these bled on catheter removal. A total of 36 complications were documented in 28 patients (29.5%). There was one death due to uncontrolled haemorrhage from the neck wound.
Conclusion
This large series highlights the ease of use of FCBT with high rates of success at haemorrhage control (97%). Venous injuries and minor arterial injuries are definitively managed with this technique.
To assess whether preserved dorsal and ventral midsagittal tissue bridges after traumatic cervical spinal cord injury (SCI) encode tract-specific electrophysiologic properties and are predictive of ...appropriate recovery.
In this longitudinal study, we retrospectively assessed MRI scans at 1 month after SCI that provided data on width and location (dorsal vs ventral) of midsagittal tissue bridges in 28 tetraplegic patients. Regression analysis assessed associations between midsagittal tissue bridges and motor- and sensory-specific electrophysiologic recordings and appropriate outcome measures at 12 months after SCI.
Greater width of dorsal midsagittal tissue bridges at 1 month after SCI identified patients who were classified as being sensory incomplete at 12 months after SCI (
= 0.025), had shorter sensory evoked potential (SEP) latencies (
= -0.57,
= 0.016), and had greater SEP amplitudes (
= 0.61,
= 0.001). Greater width of dorsal tissue bridges predicted better light-touch score at 12 months (
= 0.40,
= 0.045) independently of baseline clinical score and ventral tissue bridges. Greater width of ventral midsagittal tissue bridges at 1 month identified patients who were classified as being motor incomplete at 12 months (
= 0.002), revealed shorter motor evoked potential (MEP) latencies (r = -0.54,
= 0.044), and had greater ratios of MEP amplitude to compound muscle action potential amplitude (
= 0.56,
= 0.005). Greater width of ventral tissue bridges predicted better lower extremity motor scores at 12 months (
= 0.41,
= 0.035) independently of baseline clinical score and dorsal tissue bridges.
Midsagittal tissue bridges, detectable early after SCI, underwrite tract-specific electrophysiologic communication and are predictors of appropriate sensorimotor recovery. Neuroimaging biomarkers of midsagittal tissue bridges may be integrated into the diagnostic workup, prediction of recovery, and patients' stratification in clinical trials.
Abstracts Introduction Selective management has been the standard management protocol in penetrating neck injuries (PNIs) since this approach has significantly reduced unnecessary neck exploration. ...The purpose of this study is to evaluate outcomes of selective management in PNIs using the “no zone” approach, in which the management is guided mainly by clinical signs and symptoms, not the location of the neck wounds. Materials and methods A retrospective study was performed in patients treated for PNIs at King Chulalongkorn Memorial Hospital (KCMH) from January 2003 to December 2013. The patients with hard signs of neck injury (i.e., active bleeding, significant haematoma, massive subcutaneous emphysema, and air bubbling through the neck wound) underwent emergency neck exploration. The asymptomatic patients and the patients with soft signs (other symptoms) were considered to be candidates for selective management. Data collection included demographic data, emergency department parameters, details of neck injury, and outcomes in terms of mortality, negative exploration rate, and missed injury rate. Results Eighty-six PNI patients were treated at KCMH from 2003 to 2013, 64 of which sustained stab wounds, 12 gunshot wounds, 4 shotgun wounds, and 6 other causes. Thirty-six patients presenting with hard signs underwent immediate neck exploration and there were 2 negative explorations. Twenty-six patients with soft signs underwent selective investigations (including computed tomographic angiography in 21 patients), 5 patients required neck explorations due to positive results of the investigations with one negative exploration. All of the twenty-four asymptomatic patients were managed with close observation, none required subsequent neck exploration. There was no missed injury found in the present study. Successful non-operative management was carried out in 45 patients (52%). The overall negative exploration rate was 7% (3 in 41 patients undergoing neck exploration). Two patients with hard signs died from associated chest injuries (mortality rate 2%). Conclusion Selective management of penetrating neck injuries based on physical examination and selective use of investigations (no zone approach) is safe and simple with low negative exploration rate and no missed injury.
Background
The foley catheter balloon tamponade (FCBT) has been widely employed in the management of trauma. This study reviews our cumulative experience with the use of FCBT in the management of ...patients presenting with a penetrating neck injury (PNI).
Methods
A retrospective study was conducted at a major trauma centre in South Africa over a 9-year period from January 2012 to December 2020. All patients who presented with a PNI who had FCBT were included.
Results
A total of 1581 patients with a PNI were managed by our trauma centre, and 44 (3%) patients had an FCBT. Of the 44 cases of FCBT, stab wounds accounted for 93% (41/44) and the remaining 7% were for gunshot wounds. Seventy-five per cent of all FCBT (33/44) were inserted at a rural hospital prior to transfer to our trauma centre; the remaining 25% (11/44) were inserted in our resuscitation room. The success rate of FCBT was 80% (35/44), allowing further CT with angiography (CTA) to be performed. CTA findings were: 10/35 (29%) positive, 18/35 (51%) negative, and 7/35 (20%) equivocal. Fifteen patients required additional intervention (open surgery or endovascular intervention). The overall morbidity was 14% (6/44). Eighteen per cent required intensive care unit admission. The median length of stay was 1 day. The overall mortality rate was 11% (5/44).
Conclusion
FCBT is a simple and effective technique as an adjunct in the management of major haemorrhage from a PNI. In highly selective patients, it may also be used as definitive management.
•A three-pivot head-neck-upper torso model is used to evaluate the neck dynamics.•Four injury mechanisms are identified by different driver dynamic responses.•Injury mechanisms with large head ...rotation angles cause severe neck injuries.•Chest-first impact mechanism is more dangerous than knee-first impact mechanism.•Distance between console edge and knee bolster determines the mechanism type.
Human necks are vulnerable in train collision accidents. To design a safer cab workspace, the driver neck injury mechanism should be investigated first. In this study, this issue is addressed by investigating how neck injuries are influenced by the cab workspace dimensions. The driver-console-seat dynamic models are developed to quantify the neck injuries. The three-pivot head-neck-upper torso model is used to evaluate the relative rotation angle between head and upper torso (β+γ). The injury mechanism with the larger (β+γ) value results in more severe neck injuries. The decision tree model is established to explore the most important cab workspace dimensional parameter. The driver submarining posture (the driver exhibits the tendency of sliding down from the seat after contacting the console) generates more (β+γ) value than the flipping over behavior (the driver contacts the console and the upper body continues to move over the top of the console). Four neck injury mechanisms are classified, in which the chest-first impact mechanisms are more dangerous than the knee-first impact mechanisms. The distance between the console edge and knee bolster has the greatest effect on the neck injury. This parameter determines the injury mechanism type as it influences the first contact region of the driver. The distance between the console and seat and the pedal height are the secondary dominant attributes. These three parameters should be considered preferentially for establishing driver protection measures.
The objectives of this study were to derive lower neck injury metrics/criteria and injury risk curves for the force, moment, and interaction criterion in rear impacts for females. Biomechanical data ...were obtained from previous intact and isolated post mortem human subjects and head–neck complexes subjected to posteroanterior accelerative loading. Censored data were used in the survival analysis model. The primary shear force, sagittal bending moment, and interaction (lower neck injury criterion, LN
ic
) metrics were significant predictors of injury. The most optimal distribution was selected (Weibulll, log normal, or log logistic) using the Akaike information criterion according to the latest ISO recommendations for deriving risk curves. The Kolmogorov–Smirnov test was used to quantify robustness of the assumed parametric model. The intercepts for the interaction index were extracted from the primary risk curves. Normalized confidence interval sizes (NCIS) were reported at discrete probability levels, along with the risk curves and 95% confidence intervals. The mean force of 214 N, moment of 54 Nm, and 0.89 LN
ic
were associated with a five percent probability of injury. The NCIS for these metrics were 0.90, 0.95, and 0.85. These preliminary results can be used as a first step in the definition of lower neck injury criteria for women under posteroanterior accelerative loading in crashworthiness evaluations.
Penetrating neck injuries causing rupture of sternocleidomastoid muscle along with transection of major vessels of the neck have significant morbidity and mortality due to the risk of severe ...hemorrhage and cerebral infarction. However, there are no universal guidelines for the management of penetrating neck injuries. Here, we report a case of a 67-year-old female with a lacerated wound on the left side of the neck with a complete transection of the left sternocleidomastoid muscle along with transection of internal jugular vein and two superficial branches of internal carotid artery following penetrating injury to the neck by a bamboo stick. It was managed by emergency wound exploration with ligation of the injured vessels with repair of sternocleidomastoid muscle. Post-operatively the hemorrhage was controlled and the patient was discharged on the fourth postoperative day. Thus, in a case of penetrating injury to the neck, prompt surgical wound exploration is beneficial.
Systematic review of literature and expert clinical opinions of the members of the Spine Trauma Study Group were combined to develop and refine this algorithm.
To develop an evidence-based algorithm ...for surgical approaches to manage subaxial cervical injuries using a systematic review of the literature, expert opinion, and anticipated patient preferences.
There is lack of consensus in the management of subaxial cervical spine trauma, in part, because of the lack of a clinically relevant system for classifying these injuries. The newly developed Subaxial Injury Classification scoring system categorizes injury morphology into 3 broad groups, includes an assessment of the integrity of the discoligamentous soft tissue structures and the patient's neurologic status, and thus guides surgical or nonsurgical treatment. The choice of a specific surgical technique and approach is currently not evidence based, and this gap in knowledge is one which the current article seeks to address.
A literature review followed by a consensus of experts approach was used to develop the algorithm and to ensure face and content validity.
An algorithm is presented to guide the choice of surgical approach in cervical subaxial burst fractures, distraction injuries, and translation or rotation injuries. The burst or compression injuries and distraction injuries are more likely to be treated with a single anterior approach, whereas the more severe translation or rotation injuries may more commonly be approached posteriorly or with combined anterior and posterior surgery.
This algorithm; derived from the Subaxial Injury Classification scoring system, will assist surgeons in answering the 2 most common questions they face when managing subaxial cervical spine trauma: "Should I operate?" and "Which surgical approach should I select?"
Purpose
This project describes a morphology-based subaxial cervical spine traumatic injury classification system. Using the same approach as the thoracolumbar system, the goal was to develop a ...comprehensive yet simple classification system with high intra- and interobserver reliability to be used for clinical and research purposes.
Methods
A subaxial cervical spine injury classification system was developed using a consensus process among clinical experts. All investigators were required to successfully grade 10 cases to demonstrate comprehension of the system before grading 30 additional cases on two occasions, 1 month apart. Kappa coefficients (
κ
) were calculated for intraobserver and interobserver reliability.
Results
The classification system is based on three injury morphology types similar to the TL system: compression injuries (A), tension band injuries (B), and translational injuries (C), with additional descriptions for facet injuries, as well as patient-specific modifiers and neurologic status. Intraobserver and interobserver reliability was substantial for all injury subtypes (
κ
= 0.75 and 0.64, respectively).
Conclusions
The AOSpine subaxial cervical spine injury classification system demonstrated substantial reliability in this initial assessment, and could be a valuable tool for communication, patient care and for research purposes.
Penetrating neck trauma is uncommon in children; consequently, data describing epidemiology, injury pattern, and management are sparse. The aim of this study was to use the National Trauma Data Bank ...(NTDB) to describe pediatric penetrating neck trauma (PPNT).
The NTDB was queried for children (defined as <15 years old) with PPNT between years 2008 and 2012. Descriptive analysis was used to describe age groups (0-5, 6-10, and 11-14 years) and injury type categorized as aerodigestive, vascular, cervical spine, and nerve.
A total of 1,238 patients with penetrating neck trauma were identified among 434,788 children in the NTDB (0.28%). Mean age was 7.9 years, and 70.6% of patients were male. The most common mechanisms of injury were stabbing (44%) and gunshot/firearm (24%). Most patients were treated at a pediatric trauma center (65.8%). Computed tomographic scan was the most frequent (42.2%) diagnostic study performed, followed by laryngoscopy (27.0%) and esophagoscopy (27.4%). Almost a quarter of patients (23.7%) went directly to the operating room from the emergency department (ED). Aerodigestive injuries were most common and occurred more frequently in the youngest age group (p < 0.001). Operative procedures for aerodigestive type injuries were most common (82.7%). There were 69 deaths, yielding a mortality rate of 5.6%. When adjusting for age, admission to a pediatric trauma center, and injury type, only vascular injury (odds ratio, 3.92; 95% confidence interval, 2.19-7.24; p < 0.0001) and ED hypotension (odds ratio, 27.12; 95% confidence interval, 15.11-48.67; p < 0.0001) were found to be independently associated with death.
PPNT is extremely rare--0.28% reported NTDB incidence. Age seems to influence injury type but does not affect mortality. Computed tomographic scan is the dominant diagnostic study used for selective management. Vascular injury type and hypotension on presentation to the ED were independently associated with mortality.
Prognostic/epidemiologic study, level III.
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