patients with signs of vascular injury had injury confirmed by angiography. Using angiography as the gold standard in the 59 patients, the overall sensitivity of physical examination to detect vascular injury in stable patients with gunshot wounds to the neck was 57%. Specificity was 53%, with positive and negative predictive values of 43% and 66%.Comment: In recent years, there has been a trend towards more conservative use of catheter-based angiography in patients with possible vascular injury. This trend has been most marked in the evaluation of patients with posterior knee dislocation and in the evaluation of stable patients with penetrating trauma to an extremity. The current data, however, suggest that hemodynamically stable patients with gunshot wounds to the neck should still undergo routine imaging evaluation. In some centers, this may be duplex scanning or computed tomography angiography rather than a catheter-based angiogram.
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