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Penetrating neck injuries in children: a retrospective review
Lina Abujamra1, Madeline Matar Joseph
1Department of Emergency Medicine, the Pediatric Emergency Medicine Division, University of Florida, Health Science Center, Jacksonville 32209, USA.
Insights
Physical examination alone may suffice for managing pediatric penetrating neck injuries (PNI). Most children with PNI had minor findings and did not require invasive diagnostics or surgery, suggesting observation is a viable option.
Area of Science:
- Pediatric Trauma Surgery
- Emergency Medicine
- Clinical Management
Background:
- Penetrating neck injuries (PNI) are rare in children but pose significant management challenges.
- Existing literature on pediatric PNI evaluation and treatment is limited.
Purpose of the Study:
- To determine if physical examination is sufficient for assessing and managing pediatric PNI.
- To evaluate current management strategies for pediatric PNI.
Main Methods:
- Retrospective chart review of pediatric patients (≤16 years) with PNI.
- Study conducted at a pediatric emergency department and Level 1 trauma center.
- Data collected from January 1995 to June 2000.
Main Results:
- Thirty-one pediatric PNI cases were identified; most occurred in Zone II.
- Motor vehicle crashes and gunshot wounds were common causes.
- Only 25.8% underwent surgical exploration with no vascular injuries found; diagnostic studies were rarely needed.
Conclusions:
- PNI are infrequent in the pediatric population.
- Most pediatric PNI cases present with minor physical findings and do not necessitate extensive workup.
- Observation appears to be an acceptable management strategy for stable pediatric PNI patients.
Objective:
Penetrating Neck Injuries (PNI) are uncommon in the pediatric population, but they constitute a significant management challenge. Literature has been scant regarding the evaluation and treatment of such injuries in children. Our objective is to evaluate if physical examination alone is sufficient in the assessment and management of pediatric PNI.
Design:
Retrospective chart review.
Setting:
Pediatric emergency center of an urban emergency department (ED) and level 1 trauma center (TC).
Participants:
All patients 16 years or younger that had penetrating neck injuries between January 1995 and June 2000.
Interventions:
None.
Results:
During the study period, a total of 148,000 and 9900 patients were seen in the pediatric ED and the TC, respectively. Thirty-one children (22 males, 9 females) with PNI were identified. The median age was 9.5 years (range of 10 months to 16 years). Most children (81%) with PNI were evaluated in the TC. Motor vehicle crashes accounted for 32% of PNI and gun shot wounds for 23% of cases. Most PNI (84%) occurred in zone II of the neck. Eight patients underwent surgical exploration (25.8%) for platysmal penetration, none of which revealed any vascular injuries. Only 4 patients had barium swallows performed based on physical examination findings. All barium swallows were normal. There were no angiograms performed during the study period. A total of 3 patients died (mortality rate of 9%), all of which had major physical examination findings.
Conclusion:
PNI are infrequent in the pediatric population. Most of the patients in our review presented with minor physical examination findings and did not require exploration or diagnostic studies. Observation of the stable child in our case series was found to be an acceptable choice of management of PNI. Further prospective studies are needed to validate these results.
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