Physical examination alone is safe and accurate for evaluation of vascular injuries in penetrating Zone II neck trauma.

BACKGROUND: Optimal management of patients with Zone II penetrating neck trauma for vascular injury remains controversial. Retrospective studies have demonstrated that physical examination alone may be as accurate as arteriography in detecting significant cervical vascular injuries requiring operative repair. This study was undertaken to evaluate prospectively the safety and accuracy of physical examination in determining the management of patients with penetrating Zone II neck trauma.

STUDY DESIGN: During a 22 month period, 66 consecutive patients presented to our Level I trauma center with penetrating neck trauma. Determination of the vascular status of these patients was based on physical examination alone if the injury was located in Zone II and there was no definite sign of vascular injury. Patients were observed for at least 23 hours. Patients admitted during the first year of the study underwent ultrasound examination of the carotid artery within 48 hours to assess for injuries.

RESULTS: Thirty-six patients met admission criteria. Two patients had large lacerations requiring operative debridement and closure. Six patients underwent arteriography because of the proximity of the vertebral arteries to the injury tract, the trajectory also included Zone I or III, or there were equivocal signs of vascular injury. Each arteriogram was negative. Of the remaining 28 patients, none had any evidence of a vascular injury during hospitalization or follow-up period (mean of 1.8 months). Eighteen of the 28 patients had carotid ultrasounds, none of which showed injuries requiring operative intervention.

CONCLUSIONS: Patients with Zone II penetrating neck injuries and no definite signs of vascular injury can be safely and accurately managed on the basis of physical examination alone. Arteriography or ultrasonography are not needed to identify vascular injuries.