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Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test

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 pu...

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Autores principales: Isaza-Restrepo, Andrés, Quintero-Contreras, Julián Andrés, Escobar-DiazGranados, Jorge, Ruiz-Sternberg, Ángela María
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063736/
https://www.ncbi.nlm.nih.gov/pubmed/32151240
http://dx.doi.org/10.1186/s12873-020-00311-4
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author Isaza-Restrepo, Andrés
Quintero-Contreras, Julián Andrés
Escobar-DiazGranados, Jorge
Ruiz-Sternberg, Ángela María
author_facet Isaza-Restrepo, Andrés
Quintero-Contreras, Julián Andrés
Escobar-DiazGranados, Jorge
Ruiz-Sternberg, Ángela María
author_sort Isaza-Restrepo, Andrés
collection PubMed
description 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.
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spelling pubmed-70637362020-03-13 Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test Isaza-Restrepo, Andrés Quintero-Contreras, Julián Andrés Escobar-DiazGranados, Jorge Ruiz-Sternberg, Ángela María BMC Emerg Med Research Article 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. BioMed Central 2020-03-09 /pmc/articles/PMC7063736/ /pubmed/32151240 http://dx.doi.org/10.1186/s12873-020-00311-4 Text en © The Author(s) 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Isaza-Restrepo, Andrés
Quintero-Contreras, Julián Andrés
Escobar-DiazGranados, Jorge
Ruiz-Sternberg, Ángela María
Value of clinical examination in the assessment of penetrating neck injuries: a retrospective study of diagnostic accuracy test
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 Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063736/
https://www.ncbi.nlm.nih.gov/pubmed/32151240
http://dx.doi.org/10.1186/s12873-020-00311-4
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