Neck trauma is an uncommon but serious presenting complaint in the emergency department. Many vital structures may be affected in a patient with a traumatic neck injury, including the airway, digestive tract, and carotid and vertebral arteries. Emergency clinicians must also be prepared to diagnose and manage occult and delayed presentations of injury related to neck trauma. This supplement reviews advances and best practices in the evaluation and management of patients with neck trauma, with a focus on evidencebased guidelines. A streamlined algorithm is provided as well as discussion of recent changes and controversies in neck trauma management in the prehospital and emergency department settings.
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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.
To help the reader judge the strength of each reference, pertinent information about the study is included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the authors, are noted by an asterisk (*) next to the number of the reference.
1. Al-Thani H, El-Menyar A, Mathew S, et al. Patterns and outcomes of traumatic neck injuries: a population-based observational study. J Emerg Trauma Shock. 2015;8(3):154-158. (Retrospective analysis; 51 patients)
2. * Nowicki JL, Stew B, Ooi E. Penetrating neck injuries: a guide to evaluation and management. Ann R Coll Surg Engl. 2018;100(1):6-11. (Literature review) DOI: 10.1308/rcsann.2017.0191
3. Schaider J, Bailitz J. Neck trauma: don’t put your neck on the line. Emerg Med Pract. 2003;5(7):1-28. (Review)
4. * Irish JC, Hekkenberg R, Gullane PJ, et al. Penetrating and blunt neck trauma: 10-year review of a Canadian experience. Can J Surg. 1997;40(1):33-38. (Retrospective case series; 85 patients)
11. * Bromberg WJ, Collier BC, Diebel LN, et al. Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma. J Trauma. 2010;68(2):471-477. (Guidelines) DOI: 10.1097/TA.0b013e3181cb43da
13. Wong K. Guideline review: EAST blunt cerebrovascular injury. Accessed April 1, 2021. (Guideline review)
14. * Larson S, Delnat AU, Moore J. The use of clinical cervical spine clearance in trauma patients: a literature review. J Emerg Nurs. 2018;44(4):368-374. (Systematic literature review) DOI: 10.1016/j.jen.2017.10.013
15. * Sundstrøm T, Asbjørnsen H, Habiba S, et al. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma. 2014;31(6):531-540. (Review) DOI: 10.1089/neu.2013.3094
Subscribe to get the full list of 63 references and see how the authors distilled all of the evidence into a concise, clinically relevant, practical resource.
Keywords: neck trauma, neck injury, c-spine injury, cervical spine injury, penetrating neck trauma, blunt neck trauma, blunt cerebrovascular injury, BCVI, strangulation, hanging, near hanging, whiplash, esophageal injury, laryngotracheal injury, platysma, no zone approach, cervical spine immobilization, cervical collar, hard signs, soft signs, seatbelt sign, Canadian C-Spine Rule, NEXUS Criteria for C-Spine Imaging, CTA neck, neck hyperextension, central cord syndrome
Karen Lind, MD, MACM, FACEP; Amy Do-Nguyen, MD
Michael P. Jones, MD, FACEP; Leslie V. Simon, DO, FACEP
April 15, 2021
April 15, 2024   CME Information
4 AMA PRA Category 1 Credits.™ Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits, subject to your state and institutional approval.
Price: $99
+4 Credits!