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

Annals of Surgical Treatment and Research 2020년 99권 6호 p.352 ~ 361
고지울, 공성찬, 김명준, 정재식, 최영운, 이준혁, 정필영,
소속 상세정보
고지울 ( Ko Ji-Wool ) - Yonsei University Wonju College of Medicine Department of Surgery
공성찬 ( Gong Seong-Chan ) - Yonsei University Wonju College of Medicine Department of Surgery
김명준 ( Kim Myung-Jun ) - Yonsei University Wonju College of Medicine Department of Surgery
정재식 ( Chung Jae-Sik ) - Yonsei University Wonju College of Medicine Department of Surgery
최영운 ( Choi Young-Un ) - Yonsei University Wonju College of Medicine Department of Surgery
이준혁 ( Lee Jun-Hyuk ) - Yonsei University Wonju College of Medicine Department of Biostatistics
정필영 ( Jung Pil-Young ) - Yonsei University Wonju College of Medicine Department of Surgery

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.

키워드

Neck injuries; “No zone” approach; Trauma centers

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