Pediatric emergency medicine trisk 3551 3551
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without an increase in morbidity and mortality from operative delays while
diagnostic evaluation is being completed. CTA has been noted to be a reliable
imaging modality for detecting vascular and aerodigestive injuries, with reported
100% sensitivity and 93% specificity. In some institutions, increased use of CTA
has replaced conventional angiography for the vascular assessment of neck
injuries, resulting in fewer neck explorations, and essentially eliminating negative
exploratory surgeries. Subsequently, the use of CTA has transcribed the zone of
injury into a descriptor rather than a triage tool or guide for exploratory surgery.
Color flow Doppler (CFD) is a noninvasive, relatively sensitive screening tool
with high specificity, positive predictive value (PPV), and negative predictive
value (NPV) for vascular injury, but can be limited by adjacent or overlying
hematomas and pneumothoraces as well as the skill of the operator. Physical
examination alone has been reported to have 93% sensitivity and 87% PPV in
predicting vascular injuries. Vascular injuries and/or hypotension on presentation
to the ED are independent predictors for mortality.
Penetrating injury of the larynx and trachea occur, although blunt trauma to
these areas is more common and can be associated with significant morbidity and
mortality (see Chapter 118 ENT Emergencies ).
Clinical Considerations
Clinical Recognition
While penetrating neck trauma is rare in children, if a child presents with a history
consistent with this type of injury, the clinician should have a high index of
suspicion for potential injuries based on the penetrating object, force, location of
penetration, and initial clinical assessment. Consequences of missed injuries
include airway obstruction, delayed hemorrhage, neurologic compromise, and
deep neck infection, with potentially significant morbidity and mortality.
