Blunt Versus Penetrating Neck Trauma: A Retrospective Cohort Study
David Forner MD
Division of Otolaryngology – Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorChristopher W. Noel MD
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorMatthew P. Guttman MD
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorBarbara Haas MD, PhD
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Search for more papers by this authorDanny Enepekides MD, MPH
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology – Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Search for more papers by this authorMatthew H. Rigby MD, MPH
Division of Otolaryngology – Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
Search for more papers by this authorAvery B. Nathens MD, MPH, PhD
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Co-Senior Authorship
Search for more papers by this authorCorresponding Author
Antoine Eskander MD, ScM
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology – Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Co-Senior Authorship
Send correspondence to Dr. Antoine Eskander, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 047, Toronto, Ontario M4N 3M5, Canada. E-mail: [email protected]
Search for more papers by this authorDavid Forner MD
Division of Otolaryngology – Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorChristopher W. Noel MD
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorMatthew P. Guttman MD
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorBarbara Haas MD, PhD
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Search for more papers by this authorDanny Enepekides MD, MPH
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology – Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Search for more papers by this authorMatthew H. Rigby MD, MPH
Division of Otolaryngology – Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
Search for more papers by this authorAvery B. Nathens MD, MPH, PhD
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Co-Senior Authorship
Search for more papers by this authorCorresponding Author
Antoine Eskander MD, ScM
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
Department of Otolaryngology – Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Co-Senior Authorship
Send correspondence to Dr. Antoine Eskander, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 047, Toronto, Ontario M4N 3M5, Canada. E-mail: [email protected]
Search for more papers by this authorDr. Nathens is the Director of the American College of Surgeons Trauma Quality Improvement Program, the source of data contained within the manuscript.
The authors have no funding, financial relationships, or conflicts of interest to disclose.
Abstract
Objectives/Hypothesis
Despite being common, neck injuries have received relatively little attention for important quality of care metrics. This study sought to determine the association between blunt and penetrating neck injuries on mortality and length of stay, and to identify additional patient and hospital-level characteristics that impact these outcomes.
Study Design
Retrospective cohort study utilizing the American College of Surgeons Trauma Quality Improvement Program database.
Methods
Adult patients (≥18) who sustained traumatic injuries involving the soft tissues of the neck between 2012 and 2016 were eligible. Multiple imputation was used to account for missing data. Logistic regression and negative binomial models were used to analyze 1) in-hospital mortality and 2) length of stay respectively while adjusting for potential confounders and accounting for clustering at the hospital level.
Results
In a cohort of 20,285 patients, the crude mortality rate was lower in those sustaining blunt neck injuries compared to penetrating injuries (4.9% vs. 6.0%, P < .01), while length of hospital stay was similar (median 9.9 vs. 10.2, P = 0.06). In adjusted analysis, blunt neck injuries were associated with a reduced odds of mortality during hospital admission (odds ratio: 0.66, 95% confidence intervals [0.564, 0.788]), as well as significant reductions in length of stay (rate ratio: 0.92, 95% confidence intervals [0.880, 0.954]).
Conclusions
Blunt neck injuries are associated with lower mortality and length of stay compared to penetrating injuries. Areas of future study have been identified, including elucidation of processes of care in specific organs of injury.
Level of Evidence: Level 3 Laryngoscope, 131:E1109–E1116, 2021
Supporting Information
| Filename | Description |
|---|---|
| lary29088-sup-0001-Tables.docxWord 2007 document , 49.1 KB | Supplemental Table S1 Abbreviated Injury Scale codes for defining soft tissue neck injury. Supplemental Table S2. Abbreviated Injury Scale codes for defining major head and brain trauma. Supplemental Table S3. Baseline clinical and demographic characteristics of patients who died in the emergency department. Supplemental Table S4. Comparison between those observations with no missing data and those with any missing data. Supplemental Table S5. Unadjusted analysis of primary outcome (death in hospital) Supplemental Table S6. Comparison of the three primary outcome model iterations. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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