Computed tomography angiography in the "no-zone" approach era for penetrating neck trauma: A systematic review

Kareem Ibraheem, Sunnie Wong, Alison Smith, Chrissy Guidry, Patrick McGrew, Clifton McGinness, Juan Duchesne, Sharven Taghavi, Charles Harris, Rebecca Schroll

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

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. METHODS We performed a systematic review using an electronic search of three databases (PubMed, Medline, Cochrane Review) from 2000 to 2017. 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%. 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. LEVEL OF EVIDENCE Systematic review, level IV.

Original languageEnglish (US)
Pages (from-to)1233-1238
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume89
Issue number6
DOIs
StatePublished - Dec 2020
Externally publishedYes

Keywords

  • Penetrating trauma
  • angiography
  • neck
  • systematic review

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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