Transcervical gunshot injuries

Hirshberg, Asher; Wall, Matthew J.; Johnston, Robert H.; Burch, Jon M.; Mattox, Kenneth L.

doi:10.1016/0002-9610(94)90206-2

Cited by 53 publications

(26 citation statements)

References 17 publications

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“…37 Stable patients with transcervical gunshot wounds may warrant further radiographic evaluation owing to their greater injury potential and likelihood to involve more than one anatomic zone of injury. 40 D. Zone I patients without indications for neck exploration should undergo CTA of the chest and neck to evaluate for both vascular and aerodigestive injuries. Initially, CTA was primarily considered for its ability to detect vascular injury, but more recent series have demonstrated a high sensitivity for detecting aerodigestive tract injuries.…”

Section: Annotated Text For the Algorithmmentioning

confidence: 99%

Western Trauma Association Critical Decisions in Trauma

Sperry

Moore

Coimbra

et al. 2013

Journal of Trauma and Acute Care Surgery

158

114

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T his is a recommended algorithm of the Western Trauma Association for the management of penetrating neck trauma that has penetrated the platysma muscle of the neck. Because of the paucity of recent prospective randomized trials on the evaluation and management of penetrating neck injury, the current algorithm and recommendations are based on available published prospective cohort, observational, and retrospective studies and the expert opinion of the Western Trauma Association members. The algorithm (Fig. 1.) and accompanying text represents a safe and reasonable approach to this difficult injury type and attempts to incorporate the advent of recent advances in radiographic screening and selective or expectant management practice. We recognize that there will be variability in decision making, local resources, institutional consensus, and patient-specific factors that may require deviation from the algorithm presented. This annotated algorithm is meant to serve as a basis from which protocols at individual institutions can be developed or serve as a quick bedside reference for clinicians. The algorithm contains letters A through J, which correspond to the lettered text. Their purpose is to succinctly navigate the reader thru the algorithm and discuss those points, which require further elucidation or where data are lacking. 1Y3

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Section: Annotated Text For the Algorithmmentioning

confidence: 99%

Western Trauma Association Critical Decisions in Trauma

Sperry

Moore

Coimbra

et al. 2013

Journal of Trauma and Acute Care Surgery

158

114

View full text Add to dashboard Cite

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“…1,2 Hirshberg et al evaluated 34 patients with transcervical gunshot wounds, and found 2 patients (6%) with esophageal injuries. 1 Similarly, Demetriades et al examined 97 patients with transcervical gunshot wounds, and reported injury to the aerodigestive tract in 6% of patients. 2 Sheely et al documented a 22-year experience in over 700 patients with penetrating neck trauma, and found 39 patients (5.5%) with cervical esophageal injury.…”

mentioning

confidence: 98%

Esophageal Perforations: New Perspectives and Treatment Paradigms

Mattox²,

Wall³

2007

Journal of Trauma: Injury, Infection &Amp; Critical Care

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170

163

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Despite significant advances in modern surgery and intensive care medicine, esophageal perforation continues to present a diagnostic and therapeutic challenge. Controversies over the diagnosis and management of esophageal perforation remain, and debate still exists over the optimal therapeutic approach. Surgical therapy has been the traditional and preferred treatment; however, less invasive approaches to esophageal perforation continue to evolve. As the incidence of esophageal perforation increases with the advancement of invasive endoscopic procedures, early recognition of clinical features and implementation of effective treatment are essential for a favorable clinical outcome with minimal morbidity and mortality. This review will attempt to summarize the pathogenesis and diagnostic evaluation of esophageal injuries, and highlight the evolving therapeutic options for the management of esophageal perforation.

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“…We therefore separated gunshots to the neck from other trauma mechanisms. Only few studies specifically focusing on gunshots to the neck have been reported [3][4][5][6]15]. In 1979, Stromberg [15] was the first to report a study on penetrating trauma to the neck limited to only bullets as an injuring agent.…”

Section: Discussionmentioning

confidence: 99%

“…In their report they were the first to question the established policy of mandatory exploration of gunshots to the neck specifically. Hirschberg et al [4], who studied transcervical gunshots to the neck, advocated a policy of mandatory neck exploration based on increased risk of associated injuries in case the bullet had crossed the midline of the neck. In 1996, however, Demetriades et al [5] reported that routine operation for every transcervical gunshot wound is not necessary.…”

Section: Discussionmentioning

confidence: 99%

Is Routine Angiography Necessary in Patients with a Gunshot Wound to the Neck? A Retrospective Analysis

Deurzen

Verleisdonk

2002

Eur J Trauma

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Aim: The aim of this study was to investigate the implication of clinical findings of vascular injury and routinely employing angiography in patients who sustained a gunshot to the neck. Patients and Methods: We retrospectively studied the demographics, bullet tract, clinical findings, diagnostic investigations, methods of treatment, outcome, and time in hospital of 70 patients who sustained a gunshot to the neck and who all underwent angiography. Results: In nine cases angiography revealed lesions to the common carotid artery (four patients), internal carotid artery (three patients), vertebral artery (one patient), and lingual artery (one patient). Physical examination had already indicated vascular damage in seven of these patients with findings such as expanding hematoma (four patients), absent carotid pulsations (two patients), bruit (one patient), and hypovolemic shock (one patient). Subsequently, these seven patients were treated operatively by performing elective neck exploration. Of these seven patients who underwent surgical repair, vascular damage was already suspected based on physical examination. The two patients with injury on angiography without clinical evidence did not deteriorate on conservative management. Conclusions: Careful clinical assessment proves to be a useful instrument in determining the necessity of surgical exploration. In our experience in 70 patients, the results of angiography did not alter the management of the patients who sustained a gunshot to the neck.Our results on conservative management with selective angiography indicate that morbidity and mortality of unnecessary neck explorations are avoided without increased risk.

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Transcervical gunshot injuries

Cited by 53 publications

References 17 publications

Western Trauma Association Critical Decisions in Trauma

Western Trauma Association Critical Decisions in Trauma

Esophageal Perforations: New Perspectives and Treatment Paradigms

Is Routine Angiography Necessary in Patients with a Gunshot Wound to the Neck? A Retrospective Analysis

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