Dataset of A Review of Penetrating Neck Injuries at Two Urban Hospitals in Jamaica

Published: 11-07-2018| Version 2 | DOI: 10.17632/87jn7b3kr3.2
Alfred Duncan


Research Hypothesis : Clinical examination by trained physicians is a sensitive and specific tool in predicting the presence of a penetrating neck injury which ultimately will require surgical intervention. Objectives This study will determine the following: 1) The incidence of penetrating neck injury in two referral centres in Jamaica i.e. The Kingston Public Hospital and the University Hospital of The West Indies. 2) Clinical characteristics of injury of the patients. 3)Determine the sensitivity of clinical examination in predicting necessity for surgrical Research Methodology All patients with a provisional diagnosis of penetrating neck injury were included in the study as evidenced by breach of the platysmas layer of the neck in clinical examination. The Patient population was divided into two groups. The first group of patients who were managed with operative exploration included those persons demonstrating hard signs of injury as well as those with clinical suspicion of pharyngo-oesophageal injuries based on the presence of hematemesis , unremitting odynophagia or active saliva draining from the wound. The second group of patients were managed non operatively and included those patients who were asymptomatic of the injury ( with no clinical suspicion of airway pharyngo-oesophageal injury ) as well as those who were symptomatic of their injury but based on clinical assessment did not require any surgical intervention. Clinical examination findings were performed by the most senior physician to assess these patients and the results were compared to intraoperative findings in those patients who had on surgical management . Those clinical examination findings of patients who were managed non operatively were compared to CT angiographic findings. Thus we were able to calculate sensitivity, specificity positive and negative predictive values of clinical examination . Findings of Research 1) There were 152 patients enrolled in this study, 135 male patients , 17 female patients. There were no cases of mortality during the period of study. 2) Males were statistically more likely to present as victims of penetrating neck injury (p<0.01) 3)Knives were implicated in the mechanism of trauma in 55 % of cases, Gunshot wounds in 24.5% of cases. 4) Zone 2 of the neck was the most commonly injured zone (46.5%) 5) The sensitivity of physical examination to detect the presence of a vascular injury in our study was 87.5% with a specificity of 69.23% and an overall diagnostic accuracy of 74.55%. The diagnostic accuracy of clinical examination in detecting the presence of a vascular injury however, was found to vary by zone, with Zone 1 (45.45%) ,Zone 2 (82.61%) and Zone 3 (75%) diagnostic accuracy reported. 6) The sensitivity of physical examination to detect the presence of digestive tract (Pharyngo-oesophageal) injury was 70% with a specificity of 68.89% and an overall diagnostic accuracy of 69.09%.


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Descriptive Statistics Analysis: All variables were analysed by age, sex and injury weapon. Non-parametric variables were presented as frequencies, rates and cross-tabulations. Parametric variables such as age, were presented as means with 95% confidence intervals, standard error values and standard deviations. Bivariate analyses were performed using chi-squared, unpaired T-tests and correlations. Data was analysed using SPSS.