Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (2024)

Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (1) https://doi.org/10.1097/ta.0000000000002919 · Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (2)

Journal: Journal of Trauma and Acute Care Surgery, 2020, №6, p.1233-1238

Publisher: Ovid Technologies (Wolters Kluwer Health)

Authors:

  1. Kareem Ibraheem
  2. Sunnie Wong
  3. Alison Smith
  4. Chrissy Guidry
  5. Patrick McGrew
  6. Clifton McGinness
  7. Juan Duchesne
  8. Sharven Taghavi
  9. Charles Harris
  10. Rebecca Schroll

Abstract

<jats:sec> BACKGROUND Penetrating neck trauma (PNT) continues to present a diagnostic dilemma. Practice guidelines advocate the use of computed tomography angiography (CTA) for suspected vascular or aerodigestive injuries in all neck zones. There is also an evolving evidence of “no-zone” approach where the decision to obtain a CTA is guided by physical examination findings and clinical presentation. The aim of this systematic review was to examine existing literature on the diagnostic accuracy of CTA as an integral component of the no-zone approach in stable patients with PNT. </jats:sec> <jats:sec> METHODS We performed a systematic review using an electronic search of three databases (PubMed, Medline, Cochrane Review) from 2000 to 2017. </jats:sec> <jats:sec> RESULTS A total of 5 prospective and 8 retrospective studies were included. The sensitivity of CTA ranged from 83% to 100%; specificity, from 61% to 100%; positive predictive value, from 30% to 100%; and negative predictive value, from 90% to 100%. Three studies reported high sensitivity and specificity for the detection of vascular injuries but low specificity for aerodigestive tract injuries. When stratified by clinical presentation, CTA had a sensitivity of 89.5% to 100% and specificity of 61% to 100% in stable patients presenting with soft signs (SSs). In a combined group of stable patients with either hard signs (HSs) or SSs, the sensitivity of CTA was 94.4% to 100% and the specificity was 96.7% to 100%. Among patients presenting with HSs, the sensitivity of CTA was 78.6% to 90% and the specificity was 100%. </jats:sec> <jats:sec> CONCLUSIONS This is the first systematic review to examine the role of CTA in PNT. In combination with physical examination, CTA demonstrated a reliable high sensitivity and specificity for detecting injuries in PNT in stable patients with SSs of injury and select patients with HSs of injury. These results support the management of PNT using no-zone approach based on physical examination and the use of CTA in stable patients. </jats:sec> <jats:sec> LEVEL OF EVIDENCE Systematic review, level IV. </jats:sec>

List of references

  1. Clinical practice guideline: penetrating zone II neck trauma, J Trauma, № 64, с. 1392
  2. Penetrating wounds of the neck, Am J Surg, № 91, с. 581
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (3) https://doi.org/10.1016/0002-9610(56)90289-6
  3. Penetrating wounds of the neck: a military and civilian experience, Arch Surg, № 99, с. 307
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (4) https://doi.org/10.1001/archsurg.1969.01340150015003
  4. Evaluation and treatment of penetrating cervical injuries, J Trauma, № 19, с. 391
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (5) https://doi.org/10.1097/00005373-197906000-00001
  5. Selective management of penetrating neck injuries using “no zone” approach, Injury, № 46, с. 1720
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (6) https://doi.org/10.1016/j.injury.2015.06.019
  6. Reliability of physical examination as a predictor of vascular injury after penetrating neck trauma, Am Surg, № 69, с. 804
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (7) https://doi.org/10.1177/000313480306900915
  7. Redefining the role of arterial imaging in the management of penetrating zone 3 neck injuries, Vascular, № 13, с. 158
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (8) https://doi.org/10.1258/rsmvasc.13.3.158
  8. Penetrating zone II neck injury: does dynamic computed tomographic scan contribute to the diagnostic sensitivity of physical examination for surgically significant injury? A prospective blinded study, J Trauma Acute Care Surg, № 54, с. 61
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (9) https://doi.org/10.1097/00005373-200301000-00008
  9. Continued experience with physical examination alone for evaluation and management of penetrating zone 2 neck injuries: results of 145 cases, J Vasc Surg, № 32, с. 483
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (10) https://doi.org/10.1067/mva.2000.109333
  10. Is exploration mandatory in penetrating zone II neck injuries?, ANZ J Surg, № 77, с. 261
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (11) https://doi.org/10.1111/j.1445-2197.2007.04030.x
  11. “No zone” approach in penetrating neck trauma reduces unnecessary computed tomography angiography and negative explorations, J Surg Res, № 221, с. 113
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (12) https://doi.org/10.1016/j.jss.2017.08.033
  12. Physical examination alone is safe and accurate for evaluation of vascular injuries in penetrating Zone II neck trauma, J Am Coll Surg, № 179, с. 657
  13. Evaluation of multidetector computed tomography for penetrating neck injury: a prospective multicenter study, J Trauma Acute Care Surg, № 72, с. 576
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (13) https://doi.org/10.1097/TA.0b013e31824badf7
  14. Computed tomographic angiography as an aid to clinical decision making in the selective management of penetrating injuries to the neck: a reduction in the need for operative exploration, J Trauma Acute Care Surg, № 64, с. 1466
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (14) https://doi.org/10.1097/TA.0b013e3181271b32
  15. Role of computed tomography angiography in the management of Zone II penetrating neck trauma in patients with clinical hard signs, J Trauma Acute Care Surg, № 79, с. 943
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (15) https://doi.org/10.1097/TA.0000000000000713
  16. Computed tomography angiography is the definitive vascular imaging modality for penetrating neck injury: a South African experience, Scand J Surg, № 107, с. 23
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (16) https://doi.org/10.1177/1457496917731187
  17. Western Trauma Association critical decisions in trauma: penetrating neck trauma, J Trauma Acute Care Surg, № 75, с. 936
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (17) https://doi.org/10.1097/TA.0b013e31829e20e3
  18. Penetrating neck trauma: a review of management strategies and discussion of the ‘No Zone’ approach, Am Surg, № 79, с. 23
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (18) https://doi.org/10.1177/000313481307900113
  19. Evidence level of individual studies: a proposed framework for surgical research, J Trauma Acute Care Surg, № 72, с. 1484
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (19) https://doi.org/10.1097/TA.0b013e318256dc4d
  20. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration, BMJ, № 339, с. b2700
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (20) https://doi.org/10.1136/bmj.b2700
  21. Correlation between the level of the external wound and the internal injury in penetrating neck injury does not favour an initial zonal management approach, BJS Open, № 4, с. 704
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (21) https://doi.org/10.1002/bjs5.50282
  22. Penetrating aerodigestive injuries in the neck: a proposed CT-aided modified selective management algorithm, Eur Radiol, № 26, с. 2409
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (22) https://doi.org/10.1007/s00330-015-4050-3
  23. Management of penetrating neck injuries, Br J Surg, № 99, с. 149
  24. Prospective evaluation of screening multislice helical computed tomographic angiography in the initial evaluation of penetrating neck injuries, J Trauma, № 61, с. 144
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (23) https://doi.org/10.1097/01.ta.0000222711.01410.bc
  25. CT angiography in penetrating neck trauma reduces the need for operative neck exploration, Am Surg, № 71, с. 754
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (24) https://doi.org/10.1177/000313480507100912
  26. Penetrating neck injuries: helical CT angiography for initial evaluation, Radiology, № 224, с. 366
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (25) https://doi.org/10.1148/radiol.2242010973
  27. Diagnosis of arterial injuries caused by penetrating trauma to the neck: comparison of helical CT angiography and conventional angiography, Radiology, № 216, с. 356
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (26) https://doi.org/10.1148/radiology.216.2.r00jl25356
  28. Penetrating neck injuries: helical CT angiography for initial evaluation, Radiology, № 224, с. 366
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (27) https://doi.org/10.1148/radiol.2242010973
  29. Carotid vertebral trauma, J Trauma Acute Care Surg, № 9, с. 987
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (28) https://doi.org/10.1097/00005373-196912000-00003
  30. The use of the anatomic ‘zones’ of the neck in the assessment of penetrating neck injury, Am Surg, № 80, с. 970
    Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review (29) https://doi.org/10.1177/000313481408001013

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