Ann Surg Treat Res.  2020 Dec;99(6):352-361. 10.4174/astr.2020.99.6.352.

The efficacy of the “no zone” approach for the assessment of traumatic neck injury: a case-control study

• Ko JW
• Gong SC
• Kim MJ
• Chung JS
• Choi YU
• Lee JH
• Jung PY

• KMID: 2508935
• DOI: http://doi.org/10.4174/astr.2020.99.6.352

Abstract

Purpose
Recently, several studies have demonstrated symptom-based, non-zonal algorithms for approaching penetrating neck injuries. The purpose of this study was to confirm the effectiveness of the “no zone” approach in traumatic neck injuries.
Methods
Medical charts of patients with traumatic neck injuries who presented at the Regional Trauma Center in South Korea between January 2014 and December 2018 were retrospectively reviewed. Negative final neck findings (FNFs) were compared with positive FNFs (which include major vascular, aerodigestive, nerve, endocrine gland, cartilage, or hyoid bone injuries) using multivariate logistic regression analysis including values of the “zone” and/or no zone approach.
Results
Out of 168 trauma patients, 70 patients with a minor injury and 7 patients under the age of 18 years were excluded. Of the remaining 91 patients, 74 (81.3%) had penetrating neck injuries and 17 (18.7%) had blunt neck injuries. Initial diagnosis most frequently revealed external wounds in zone II (84.6%). Twenty (22.0%) and 36 (39.5%) patients had hard and soft signs, respectively, using the no zone approach. Further, there was a significant difference between the negative and positive FNFs in patients with hard signs (11.6% vs. 54.5%; P < 0.01, respectively). According to the multivariate logistic regression analysis, the hard signs were associated with an odds ratio (OR) for FNFs (OR, 18.92; 95% confidence interval, 3.55–157.60).
Conclusion
Traumatic neck injuries classified as having hard signs based on the no zone approach may be correlated with internal organ injuries of the neck.

Keyword

Neck injuries; “No zone” approach; Trauma centers

Figure

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  Fig. 1 Flowchart of study design. a)Internal organ injuries confirmed by CT scan. b)Internal organ injuries confirmed by an operation.

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  Fig. 2 A receiver operating characteristic curve and area under the curve (AUC) of multivariate logistic regression analysis for the final neck findings in total patients (A) and exploration group (B).

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