Neck Trauma: Current Guidelines For Emergency Clinicians
In this issue of EM Practice Guidelines Update, 2 guidelines that address the management of neck trauma are reviewed. Both guidelines were developed by The Eastern Association for the Surgery of Trauma (EAST). The recommendations focus on zone II penetrating neck trauma and blunt neck trauma, as the management of these 2 areas has evolved substantially in recent years. The incidence of penetrating neck trauma is reported to be approximately 1% to 5% of all traumatic injuries; blunt trauma is even more uncommon and sometimes completely overlooked.1 Management of neck trauma requires rapid and appropriate diagnostic testing to reduce morbidity and mortality; however, the evolution and proliferation of new technologies, most notably computed tomography angiography (CTA), has led to controversy around the initial management approach.
Practice Guideline Impact
- CTA can be considered as the initial diagnostic study of choice in penetrating zone II neck trauma (as well as zone I and III).
- Multidetector CTA can be considered as the initial diagnostic study of choice in blunt neck trauma/blunt cerebrovascular injury.
- Managing penetrating neck trauma by physical examination alone is not recommended.
- Cervical spine immobilization is not necessary in penetrating neck trauma without evidence of neurological deficit.
Keywords: neck trauma, penetrating neck trauma
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- » References