Different characteristics of neck trauma are usually related to the social and cultural conditions of the population. Penetrating neck injury (PNI) constitutes 5–10% of traumatic injuries in adults and has a mortality rate ranging from 10 to 15%. Any intrusion may result in life-threatening penetration of the trachea or larynx, the esophagus, major blood vessels, cervical nerve roots, cervical nerves or the spinal cord. The neck has a dense concentration of vital structures confined in a small space. It is important to emphasize the value of the clinical examination since there are many contexts in the modern world where a considerable amount of the population is afflicted by neck trauma and treated under conditions where technological resources are limited. Our study’s main findings suggest that patients with neck injuries and no vascular, airway, or gastrointestinal soft sign can be safely managed with a conservative approach. The sensitivity and negative predictive value (NPV) of any soft sign to determine injuries which require surgical repair was 97.4% and 98.7% respectively, with a range of confidence of 95%. Vascular soft signs were present in 57% ( n = 118) of the patients, soft signs of the airway and the upper gastrointestinal tract were present in 15.9% ( n = 33) and 21.3% ( n = 44) of the patients respectively. Of the total sample, 36.2% ( n = 75) of patients were considered “asymptomatic” as they didn’t present with any soft signs of injury. The sample consisted of the clinical records of 207 ( n = 207) patients who went to the emergency room for penetrating neck wounds at Hospital Occidente Kennedy (HOK).

The study was conducted at Hospital Occidente Kennedy (HOK) between August 2009 and June 2010. We performed an observational retrospective study of a diagnostic accuracy test where we compared clinical findings (symptoms and soft signs on admission of the patient) with the definitive findings according to the gold standard test for each particular situation (selective studies, clinical observation and surgical exploration). The purpose of this study was to validate thorough physical examination as a reliable diagnostic tool in these patients. There are many high-volume trauma centers in limited resource environments where a thorough clinical examination of patients may contribute to a more economical, accurate, and widely applicable method of determining the proper management of patients with penetrating neck injuries.

Hard soft signs neck trauma