Traumatic retropharyngeal hematoma without spinal cord injury or spinal fracture: a retrospective multicenter analysis

BACKGROUND: Retropharyngeal hematoma can be a life-threatening injury due to progressive upper airway obstruction. It is common following spinal cord injury or spinal fracture, and the clinical course and outcome of such patients are determined by their primary injuries. However, the natural clinical course of retropharyngeal hematoma itself remains unclear. In this study, we aimed to examine the clinical characteristics of traumatic retropharyngeal hematoma without spinal cord injury or spinal fracture (TREWISS). METHODS: We performed a multicenter retrospective analysis of patients who were diagnosed in the emergency department with soft tissue swelling of the retropharyngeal space by neck CT, between April 2010 and April 2020. The inclusion criterion was thickness of the retropharyngeal space > 7 mm at C1–C4 or > 22 mm at C5–C7 on a CT image. The exclusion criteria were (1) age < 18 years, (2) cardiopulmonary arrest, (3) other causes of soft tissue swelling besides hematoma, (4) patients with cervical spinal cord injury or spine fractures. Baseline characteristics were compared between intubated and non-intubated patients. RESULTS: Twenty-two patients were included in the analysis. Among them, 16 patients needed intubation. Median patient age was 69 years, and 27% of the patients were on antiplatelet or anticoagulant medications. The width of the hematoma on sagittal CT images was significantly wider in the intubated group [median (interquartile range), 2.5 cm (2.0–3.4) vs. 1.2 cm (0.9–1.7), p = 0.002). More than half the intubated patients needed tracheotomy. Tracheotomy was performed around day 3, and endotracheal tube was placed about 3 weeks. Only 60% of patients were successfully discharged to their homes, and one patient (6.3%) died during hospitalization. CONCLUSION: Early intubation and subsequent intensive care are important for patients with TREWISS. The patients typically require several weeks of hospitalization, although their outcomes are usually poor. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00068-022-02203-7.