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Selective surgical management in penetrating neck injuries.

OBJECTIVE
To evaluate selective operative management in penetrating neck trauma.


DESIGN
A chart review.


SETTING
A university-affiliated hospital in Johannesburg, South Africa.


PATIENTS
All adults admitted to the hospital between January 1988 and June 1993 with a penetrating neck wound. Excluded were patients in whom there was no suspicion of an occult injury that might need further investigation. There were 755 patients in the study.


INTERVENTIONS
Immediate surgical exploration (group A, 613 patients) and observation with constant monitoring (group B, 142 patients).


MAIN OUTCOME MEASURES
Unnecessary explorations in group A and missed significant injuries in group B.


RESULTS
In group A there was a 3% incidence of unnecessary explorations, and 4.2% of the patients died. In group B there was a 9.1% incidence of missed injuries, and 2.8% of the patients died as a result of the delayed diagnosis. Overall the death rate was 4%.


CONCLUSION
Selective operative intervention for penetrating neck trauma results in fewer negative explorations and a death rate comparable to those of series that support mandatory neck exploration.