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Esophageal Injury in Penetrating Neck Trauma – Is CTA Enough?

June 3, 2021

Written by Clay Smith

Spoon Feed
CTA alone was not sufficient to rule out esophageal injury in patients with penetrating neck trauma.

Why does this matter?
Morbidity from missed esophageal injury occurs in up to half of patients, and mortality is also high, in up to one-third. The quality and resolution of CTA continues to improve and is the gold standard for evaluating vascular neck injuries. Is CTA alone enough to rule out aero-digestive injuries (ADI)?

Don’t forget the food tube
This was a systematic review and meta-analysis of 7 diagnostic studies, with a total of 877 patients with penetrating neck trauma and CTA. The authors were interested whether ADI lacking “hard signs” could be detected with CTA alone. Prevalence of ADI was 13.4%. CTA was 92% sensitive, 88% specific; positive LR 12.2, negative LR 0.14. This seemed pretty good. However, when considering the 26 esophageal injuries detected at surgery or with a swallow study, 5 were initially missed on CTA. The authors concluded that CTA was not sufficient to rule out esophageal injury in patients with penetrating neck trauma.  The studies included were at risk for incorporation bias and ascertainment bias. These biases may falsely impact diagnostic accuracy.

Source
Computed Tomography Angiography for Aero-digestive Injuries in Penetrating Neck Trauma; A Systematic Review. Acad Emerg Med. 2021 May 21. doi: 10.1111/acem.14298. Online ahead of print.

What are your thoughts?