Selective management of penetrating neck trauma. Cost implications

Many authors advocate mandatory surgical exploration for all patients with penetrating neck trauma, while other maintain that with careful diagnostic evaluation some patients safely can be spared an operation. From our hospitals, 65 cases of penetrating neck trauma were reviewed, 27 of which showed no mortality without operation. Surgical exploration of the neck showing no injury added $1,930 to the cost of hospitalization. Review of the surgical literature discloses that mortalities reported by authors advocating selective and mandatory exploration are similar. The incidence of missed significant injury is low among patients observed selectively. A management algorithm for the diagnostic evaluation and treatment of patients with penetrating neck trauma is advocated. All stable patients should undergo four-vessel angiography. Studies of the cervical esophagus may be performed. Patients with entirely normal diagnostic evaluations may be observed safely, sparing unnecesary operation.