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Penetrating neck trauma in children: an urban hospital's experience
M K Kim1, R Buckman, W Szeremeta
1Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
Insights
Penetrating neck trauma in children is a serious concern. Selective management in experienced centers offers a safe and effective approach to these potentially life-threatening injuries.
Area of Science:
- Pediatric Trauma Surgery
- Emergency Medicine
- Surgical Management
Background:
- Increasing incidence of violent crime contributes to a rise in pediatric penetrating head and neck trauma.
- Effective management strategies for pediatric neck wounds are crucial.
Purpose of the Study:
- To address the methods of management for pediatric penetrating neck wounds.
- To evaluate the outcomes of selective neck exploration in children with penetrating neck trauma.
Main Methods:
- Review of clinical records for children under 18 admitted with penetrating neck injuries (1990-1997).
- Classification of injuries by type and location (zones I, II, III).
- Evaluation of demographic data, clinical presentation, diagnostic studies, and management techniques.
Main Results:
- 35 children (30 boys, 5 girls) aged 6-18 years evaluated for 31 missile and 4 stab wounds.
- Injuries distributed across zones: 14% zone I, 60% zone II, 26% zone III.
- Selective neck exploration in zone II (33% of cases) revealed significant findings in 86%; mortality rates varied by zone (I: 60%, II: 29%, III: 56%), with an overall mortality of 40%.
Conclusions:
- Penetrating neck trauma in children can result in life-threatening injuries.
- Selective management of pediatric penetrating head and neck injuries is a safe and effective policy when implemented in experienced trauma centers.
Objective:
As the incidence of violent crime increases in our society, the rate of penetrating head and neck trauma in children also rises. The methods of management of pediatric penetrating neck wounds are addressed.
Methods:
All clinical records of children younger than 18 years admitted with penetrating neck injuries between 1990 and 1997 were reviewed. The injuries were classified according to type and location of the neck wound. Demographic data, clinical presentation, diagnostic studies, and management techniques were evaluated.
Results:
Thirty-five children aged 6 to 18 years old were evaluated for 31 missile wounds and 4 stab wounds. There were 30 boys and 5 girls. Fourteen percent of injuries were in zone 1, 60% in zone II, and 26% in zone III. Of the 33% of children with zone II penetrating neck traumas who underwent selective neck explorations, 86% had significant intraoperative findings. The mortality rates for zones I, II, and III were 60%, 29%, and 56%, respectively. The overall mortality rate was 40%.
Conclusions:
Penetrating neck trauma in children may lead to potentially life-threatening injuries. Selective management of penetrating head and neck injuries in children can be a safe and effective policy in an experienced trauma center.
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