title: Safety in selective surgical exploration in penetrating neck trauma.
abstract: BACKGROUND
  Selective management of penetrating neck injuries has been considered the standard of care with minimal risks to patient safety. In a previous non-randomized prospective study conducted at our center, selective management proved to be safe and reduced unnecessary exploratory cervicotomies. In the present study, the role of clinical examination and selective diagnostic tests were assessed by reviewing demographic and clinical data. A comparison of results between two groups (mandatory surgical exploration versus selective surgical exploration) was made to check the safety of selective management in terms of the rates of morbidity and mortality.
  
  
  METHODS
  A retrospective analysis at the Emergency Department of the Hospital das Clínicas of the University of Sao Paulo was performed by a chart review of our trauma registry, identifying 161 penetrating neck trauma victims.
  
  
  RESULTS
  Of the 161 patients, 81.6 % were stabbed and 18.4 % had gunshot injuries. Stratifying the wound entry points by neck zones, we observed that zone I was penetrated in 32.8 %, zone II in 44.1 % and zone III in 23.1 % of all the cases. Thirty one patients (19.2 %) had immediate surgical exploration, which had a mean length of stay of 6 days, a complication rate of 12.9 % and a mortality rate of 9.4 %. Of the 130 who underwent selective surgical exploration 34 (26.1 %) required operative procedures after careful physical examination and diagnostic testing based on clinical indications. The mean length of stay for the selective surgical exploration group was 2 days with a complication rate of 17.6 % with no mortality, and virtually all of them were related to associated injuries in distant body segment. No statistical significance was found comparing mortality and complication rates between the two groups. Selective approach avoided 59 % of unnecessary exploratory cervicotomies.
  
  
  CONCLUSIONS
  Careful evaluation of asymptomatic and stable patients with minor signs of injury can safely avoid unnecessary neck explorations with low rates of morbidity. This should be the standard management of such patients.
authors.affiliation: Departament of Surgery, Division of Surgical Clinic III, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Frederico
authors.initials: F
authors.lastname: Teixeira
authors.affiliation: Departament of Surgery, Division of Surgical Clinic III, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Carlos Augusto Metidieri
authors.initials: CA
authors.lastname: Menegozzo
authors.affiliation: Departament of Surgery, Division of Surgical Clinic III, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Sérgio Dias do Couto
authors.initials: SD
authors.lastname: Netto
authors.affiliation: Departament of Surgery, Division of Surgical Clinic III, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Renato S
authors.initials: RS
authors.lastname: Poggeti
authors.affiliation: Departament of Surgery, Division of Surgical Clinic III, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Francisco de Sales
authors.initials: Fde S
authors.lastname: Collet E Silva
authors.affiliation: Departament of Surgery, Division of Surgical Clinic III, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Dario
authors.initials: D
authors.lastname: Birolini
authors.affiliation: Departament of Surgery, Division of Surgical Clinic III, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Celso de Oliveira
authors.initials: Cde O
authors.lastname: Bernini
authors.affiliation: Departament of Surgery, Division of Surgical Clinic III, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Edivaldo Massazo
authors.initials: EM
authors.lastname: Utiyama
keywords: Cervical trauma; Neck injury; Penetrating trauma; Surgical selective management