NDLI: Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test

Content Provider	Springer Nature : BioMed Central
Author	Isaza-Restrepo, Andrés Quintero-Contreras, Julián Andrés Escobar-DiazGranados, Jorge Ruiz-Sternberg, Ángela María
Abstract	Background 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. The purpose of this study was to validate thorough physical examination as a reliable diagnostic tool in these patients. Methods 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 study was conducted at Hospital Occidente Kennedy (HOK) between August 2009 and June 2010. Results 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). Of the total sample, 36.2% (n = 75) of patients were considered “asymptomatic” as they didn’t present with any soft signs of injury. 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. The sensitivity and negative predictive value (NPV) of any soft sign to determine injuries which require surgical repair was 97.4% [CI] [86.5–99.5%] and 98.7% [CI] [92.8–99.8%] respectively, with a range of confidence [CI] of 95%. Conclusions 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. 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.
Related Links	https://bmcemergmed.biomedcentral.com/counter/pdf/10.1186/s12873-020-00311-4.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
DOI	10.1186/s12873-020-00311-4
Journal	BMC Emergency Medicine
Issue Number	1
Volume Number	20
Language	English
Publisher	BioMed Central
Publisher Date	2020-03-09
Access Restriction	Open
Subject Keyword	Emergency Medicine Medicine Public Health Penetrating neck injuries Vascular Airway and gastrointestinal signs Health resources Medicine/Public Health
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine
Journal Impact Factor	2.3/2023
5-Year Journal Impact Factor	2.5/2023

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