Computed tomography as a diagnostic tool in imaging of neck injuries in a large trauma unit in Gauteng

Abstract

INTRODUCTION: Sparse data exists on computed tomography (CT) imaging evaluation of neck injuries in South Africa and no data found on the incidence in Gauteng province. The rates of South African crime and trauma are high with commonest being the penetrating neck trauma. AIM: This study aims to audit and review findings of CT scans of the neck requested for patients with neck trauma, summarizing and categorizing them according to mechanism of injury and the systems injured. METHOD: A retrospective qualitative cross-sectional study evaluating and auditing 200 CT scan reports of male and female patients of all age groups with neck trauma and referred from the Emergency Trauma unit of Chris Hani Baragwanath Academic hospital. CT scan reports from the 01 January 2017 to 25 January 2018 accessed from Picture Archiving and Communication System (PACS). RESULTS: A total of 200 CT scan reports were audited and descriptive statistics of percentage and frequencies used to summarize the categorical variables. The median age was 25 years and the majority (84.50%) of the participants were males. Median time of the scan was 22:00. 26% and 19.5% of the scans were performed on Saturday and Sunday respectively and the least on Thursday (7%). The commonest type of injury was penetrating injuries (83%). Stab (67%) followed by gunshot (12.5%) injuries were the most common causes. Soft tissue injuries were the most common recorded damages (79%) followed by respiratory (36%) and injury to blood vessels (22.5%). The oesophagus was the most damaged gastrointestinal structure. CONCLUSIONS: This audit of CT scan reports of patients who experienced neck trauma showed a considerable number of male patients’ involvement ranging from 21-30 years old. Penetrating neck injury (PNI) being the most common mechanism of injury. Female patients showed more blunt neck injuries than penetrating mechanisms. Most blunt neck injuries resulted from attempted hanging associated with parasuicide followed by strangulation and Motor Vehicle accident (MVA). Our study demonstrated that most neck trauma occurred on weekends and was associated with alcohol consumption. CT angiogram has been proven to be a diagnostic imaging tool in patients with neck injuries in Gauteng. It aids in guidance of further management of these patients. Our study aimed to improve reporting of potential neck injuries, and this was initiated as a contribution to the development of reporting templates so that vital structures are assessed for definitive patient management.