Penetrating neck trauma : sensitivity of clinical examination and cost-effectiveness of angiography.
To evaluate penetrating neck trauma for (a) sensitivity of the clinical examination as an indicator of clinically significant vascular injury, and (b) cost-effectiveness of performing screening diagnostic angiography.
The medical records of all patients with penetrating neck trauma presenting at our institution over 4 years were retrospectively reviewed.
Injuries were classified into one of three anatomic zones and classified into four mutually exclusive groups based on the extent of vascular injury :
(a) no vascular injury ;
(b) minor vascular abnormality ;
(c) major vascular abnormality without a change in clinical management ;
or (d) any injury requiring a change in clinical management.
Cost data were also obtained for each patient's hospitalization.
There were 111 patients with penetrating neck trauma.
No statistically significant difference between the sensitivities of the clinical examination or angiography for the detection of vascular injury were detected.
Of the 48 patients who had vascular injuries, 45 had an abnormal clinical findings (93.7% sensitivity).
None of the remaining 3 patients with vascular injury and normal clinical findings would have had their treatment altered by the results of angiography.
The calculated cost of using angiography as a screening tool for vascular injury in patients with normal clinical findings was approximately $3.08 million per central nervous system event prevented.
Mots-clés Pascal : Traumatisme, Artère, Cou, Veine, Economie santé, Critère performance, Clinique, Corrélation, Angiographie, Indication, Technique, Exploration, Diagnostic, Homme, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Artère pathologie, Veine pathologie, Radiodiagnostic
Mots-clés Pascal anglais : Trauma, Artery, Neck, Vein, Health economy, Performance requirement, Clinic, Correlation, Angiography, Indication, Technique, Exploration, Diagnosis, Human, Cardiovascular disease, Vascular disease, Arterial disease, Venous disease, Radiodiagnosis
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0278479
Code Inist : 002B24B04. Création : 01/03/1996.