Reading the signs in penetrating cervical vascular injuries: Analysis of hard/soft signs and initial management from a nationwide vascular trauma database. Issue 5 (12th November 2022)

• Record Type: Journal Article
• Authors: Marrotte, Alexander; Calvo, Richard Y.; Badiee, Jayraan; Rooney, Alexandra S.; Krzyzaniak, Andrea; Sise, Michael; Bansal, Vishal; DuBose, Joseph; Martin, Matthew J.
• Other Names: Bee Tiffany author non-byline.; Lenart Emily author non-byline.; Moyer Suzanne author non-byline.; Morrison Jonny author non-byline non-byline.; Feliciano David author non-byline.; Scalea Thomas M. author non-byline.; Skarupa David author non-byline.; Mull Jennifer A. author non-byline.; Zuniga Yohan Diaz author non-byline.; Podbielski Jeanette M. author non-byline.; Jost Garrett author non-byline.; Catalano Richard D. author non-byline.; Abou-Zamzam Ahmed M. author non-byline.; Luo-Owen Xian author non-byline.; Kim Jennie author non-byline.; Inaba Kenji author non-byline.; Poulin Nathaniel author non-byline.; Myers John author non-byline.; Johnson Michael author non-byline.; Rocchi Kristin author non-byline.; Bini John K. author non-byline.; Pringle Joshua author non-byline.; Herzing Karen author non-byline.; Nolan Kailey author non-byline.; Gilani Ramyar author non-byline.; Smith Tikesha author non-byline.; Knight Reginva author non-byline.; Hammer Peter author non-byline.; Trexler Scott T. author non-byline.; Namias Nicholas author non-byline.; Meizoso Jonathan P. author non-byline.; Asensio Juan author non-byline.; Galante Joseph M. author non-byline.; Humphries Misty author non-byline.; Rajani Ravi R. author non-byline.; Benarroch-Gampel Jaime author non-byline.; Ramos Christopher author non-byline.; Dulabon George author non-byline.; Karmy-Jones Riyad author non-byline.; Larentzakis Andreas author non-byline.; Velmahos George author non-byline.; Agarwal Suresh author non-byline.; Badiee Jayraan author non-byline.; Sise Michael author non-byline.; Martin Matthew author non-byline.; Cucher Daniel author non-byline.; Taylor Annette author non-byline.; Tanner Charlotte author non-byline.; Vinces Fausto Y. author non-byline.; Docimo Salvatore author non-byline.; Carrick Matthew M. author non-byline.; Rodkey Kathy author non-byline.; Hirji Sameer author non-byline.; Askari Reza author non-byline.; Moore Forrest O. author non-byline.; Butler Richard author non-byline.; Haan James author non-byline.; Lightwine Kelly author non-byline.;
• Is Part Of: Journal of trauma and acute care surgery. Volume 93:Issue 5(2022)
• Page Start: 632
• Page End: 638
• Publication Date: 2022-11-12
• Subjects: Penetrating neck -- trauma -- vascular trauma -- hard signs; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000003678
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : CT imaging can facilitate endovascular options or nonoperative management for Penetrating Cervical Vascular Injuries with Hard Signs. Abstract : BACKGROUND: Algorithms for management of penetrating cervical vascular injuries (PCVIs) commonly call for immediate surgery with "hard signs" and imaging before intervention with "soft signs." We sought to analyze the association between initial examination and subsequent evaluation and management approaches. METHODS: Analysis of PCVIs from the American Association for the Surgery of Trauma Prospective Observational Vascular Injury Treatment vascular injury registry from 25 US trauma centers was performed. Patients were categorized by initial examination findings of hard signs or soft signs, and subsequent imaging and surgical exploration/repair rates were compared. RESULTS: Of 232 PCVI patients, 110 (47%) had hard signs (hemorrhage, expanding hematoma, or ischemia) and 122 (53%) had soft signs. With hard signs, 61 (56%) had immediate operative exploration and 44% underwent computed tomography (CT) imaging. After CT, 20 (18%) required open surgical repair, and 7% had endovascular intervention. Of note, 21 (19%) required no operative intervention. A total of 122 patients (53%) had soft signs on initial examination; 37 (30%) had immediate surgery, and 85 (70%) underwent CT imaging. After CT, 9% had endovascular repair, 7% had open surgery, and 65 (53%) were observed. No difference in mortality was observed for hard signs patients undergoing operative management versus observation alone (23% vs. 17%, p = 0.6). Those with hemorrhage as the primary hard signs most often required surgery (76%), but no interventions were required in 19% of hemorrhage, 20% of ischemia, and 24% of expanding hematoma. CONCLUSION: Although hard signs in PCVIs are associated with the need for operative intervention, initial CT imaging can facilitate endovascular options or nonoperative management in a significant subgroup. Hard signs should not be considered an absolute indication for immediate surgical exploration. LEVEL OF EVIDENCE: Prognostic/Epidemiological; Level IV. Abstract :