Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test
Abstract Background There are many high-volume trauma centers in limited resource environments where a thorough clinical examination of patients may contribute to a more economical, accurate, and widely applicable method of determining the proper management of patients with penetrating neck injuries...
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| Format: | Article |
| Language: | English |
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BMC
2020-03-01
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| Series: | BMC Emergency Medicine |
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| Online Access: | http://link.springer.com/article/10.1186/s12873-020-00311-4 |
| _version_ | 1818261869690880000 |
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| author | Andrés Isaza-Restrepo Julián Andrés Quintero-Contreras Jorge Escobar-DiazGranados Ángela María Ruiz-Sternberg |
| author_facet | Andrés Isaza-Restrepo Julián Andrés Quintero-Contreras Jorge Escobar-DiazGranados Ángela María Ruiz-Sternberg |
| author_sort | Andrés Isaza-Restrepo |
| collection | DOAJ |
| description | Abstract Background There are many high-volume trauma centers in limited resource environments where a thorough clinical examination of patients may contribute to a more economical, accurate, and widely applicable method of determining the proper management of patients with penetrating neck injuries. The purpose of this study was to validate thorough physical examination as a reliable diagnostic tool in these patients. Methods We performed an observational retrospective study of a diagnostic accuracy test where we compared clinical findings (symptoms and soft signs on admission of the patient) with the definitive findings according to the gold standard test for each particular situation (selective studies, clinical observation and surgical exploration). The study was conducted at Hospital Occidente Kennedy (HOK) between August 2009 and June 2010. Results The sample consisted of the clinical records of 207 (n = 207) patients who went to the emergency room for penetrating neck wounds at Hospital Occidente Kennedy (HOK). Of the total sample, 36.2% (n = 75) of patients were considered “asymptomatic” as they didn’t present with any soft signs of injury. Vascular soft signs were present in 57% (n = 118) of the patients, soft signs of the airway and the upper gastrointestinal tract were present in 15.9% (n = 33) and 21.3% (n = 44) of the patients respectively. The sensitivity and negative predictive value (NPV) of any soft sign to determine injuries which require surgical repair was 97.4% [CI] [86.5–99.5%] and 98.7% [CI] [92.8–99.8%] respectively, with a range of confidence [CI] of 95%. Conclusions Our study’s main findings suggest that patients with neck injuries and no vascular, airway, or gastrointestinal soft sign can be safely managed with a conservative approach. It is important to emphasize the value of the clinical examination since there are many contexts in the modern world where a considerable amount of the population is afflicted by neck trauma and treated under conditions where technological resources are limited. |
| first_indexed | 2024-12-12T18:54:05Z |
| format | Article |
| id | doaj.art-47bbfcaa0e914783b8cb7c36b48c6b9f |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-12-12T18:54:05Z |
| publishDate | 2020-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-47bbfcaa0e914783b8cb7c36b48c6b9f2022-12-22T00:15:17ZengBMCBMC Emergency Medicine1471-227X2020-03-012011810.1186/s12873-020-00311-4Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy testAndrés Isaza-Restrepo0Julián Andrés Quintero-Contreras1Jorge Escobar-DiazGranados2Ángela María Ruiz-Sternberg3Escuela de Medicina y Ciencias de la Salud. Grupo de Investigación Clínica, Universidad del RosarioHospital Emiro Quintero CañizaresEscuela de Medicina y Ciencias de la Salud. Grupo de Investigación Clínica, Universidad del RosarioEscuela de Medicina y Ciencias de la Salud. Grupo de Investigación Clínica, Universidad del RosarioAbstract Background There are many high-volume trauma centers in limited resource environments where a thorough clinical examination of patients may contribute to a more economical, accurate, and widely applicable method of determining the proper management of patients with penetrating neck injuries. The purpose of this study was to validate thorough physical examination as a reliable diagnostic tool in these patients. Methods We performed an observational retrospective study of a diagnostic accuracy test where we compared clinical findings (symptoms and soft signs on admission of the patient) with the definitive findings according to the gold standard test for each particular situation (selective studies, clinical observation and surgical exploration). The study was conducted at Hospital Occidente Kennedy (HOK) between August 2009 and June 2010. Results The sample consisted of the clinical records of 207 (n = 207) patients who went to the emergency room for penetrating neck wounds at Hospital Occidente Kennedy (HOK). Of the total sample, 36.2% (n = 75) of patients were considered “asymptomatic” as they didn’t present with any soft signs of injury. Vascular soft signs were present in 57% (n = 118) of the patients, soft signs of the airway and the upper gastrointestinal tract were present in 15.9% (n = 33) and 21.3% (n = 44) of the patients respectively. The sensitivity and negative predictive value (NPV) of any soft sign to determine injuries which require surgical repair was 97.4% [CI] [86.5–99.5%] and 98.7% [CI] [92.8–99.8%] respectively, with a range of confidence [CI] of 95%. Conclusions Our study’s main findings suggest that patients with neck injuries and no vascular, airway, or gastrointestinal soft sign can be safely managed with a conservative approach. It is important to emphasize the value of the clinical examination since there are many contexts in the modern world where a considerable amount of the population is afflicted by neck trauma and treated under conditions where technological resources are limited.http://link.springer.com/article/10.1186/s12873-020-00311-4Penetrating neck injuriesVascularAirway and gastrointestinal signsHealth resources |
| spellingShingle | Andrés Isaza-Restrepo Julián Andrés Quintero-Contreras Jorge Escobar-DiazGranados Ángela María Ruiz-Sternberg Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test BMC Emergency Medicine Penetrating neck injuries Vascular Airway and gastrointestinal signs Health resources |
| title | Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test |
| title_full | Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test |
| title_fullStr | Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test |
| title_full_unstemmed | Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test |
| title_short | Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test |
| title_sort | value of clinical examination in the assessment of penetrating neck injuries a retrospective study of diagnostic accuracy test |
| topic | Penetrating neck injuries Vascular Airway and gastrointestinal signs Health resources |
| url | http://link.springer.com/article/10.1186/s12873-020-00311-4 |
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