THE USE OF COMPUTED TOMOGRAPHIC ANGIOGRAPHY IN THE EVALUATION OF UPPER DIGESTIVE TRACT INJURIES IN PENETRATING NECK TRAUMA

Patients who present with penetrating neck injuries undergo both a computed tomographic angiogram (CTA) of the neck to diagnose vascular injuries and a contrasted swallow to diagnose aerodigestive tract injuries. In a resource constrained setting this algorithm is questionable. A chart review was performed of all patients who presented to Tygerberg Hospital's trauma unit with penetrating neck injury between 1 January 2013 and 1 January 2016. All unstable patients taken directly to theatre were excluded. The haemodynamically stable patients underwent both a CTA and contrasted swallow. All the CTAs were performed prior to contrast swallow. Of 906 patients, 825 (91%) had stab and 81 (9%) gunshot wounds. Thirty-three (3.6%) patients were diagnosed with upper digestive tract injuries on contrasted swallow. 24 patients had pharyngeal injuries and 9 patients had oesophageal injuries. CTA was suspicious of injury in 16 patients and diagnostic of injury in 4 patients. In 12 CTA scans performed there was no mention of upper digestive tract evaluation. One CTA was falsely negative for injury when compared to contrast swallow. CTA reporting does not consistently evaluate the upper digestive tract for injuries. This might be due to reliance on contrasted swallows for diagnosis. There needs to be implementation of standardised reporting on the upper digestive tract when evaluating CTAs for penetrating neck injuries. Further evaluation of the diagnostic accuracy of CTA is needed before contrasted swallows can be omitted in the absence of upper digestive tract injury suggested by CTA.