There are many high-volume trauma centers in limited resource environments where a thorough clinical examination of patients may contribute to a more economical, accurate, and widely applicable method of determining the proper management of patients with penetrating neck injuries. The purpose of this study was to validate thorough physical examination as a reliable diagnostic tool in these patients. We performed an observational retrospective study of a diagnostic accuracy test where we compared clinical findings (symptoms and soft signs on admission of the patient) with the definitive findings according to the gold standard test for each particular situation (selective studies, clinical observation and surgical exploration). The study was conducted at Hospital Occidente Kennedy (HOK) between August 2009 and June 2010. The sample consisted of the clinical records of 207 (n = 207) patients who went to the emergency room for penetrating neck wounds at Hospital Occidente Kennedy (HOK). Of the total sample, 36.2% (n = 75) of patients were considered “asymptomatic” as they didn’t present with any soft signs of injury. Vascular soft signs were present in 57% (n = 118) of the patients, soft signs of the airway and the upper gastrointestinal tract were present in 15.9% (n = 33) and 21.3% (n = 44) of the patients respectively. The sensitivity and negative predictive value (NPV) of any soft sign to determine injuries which require surgical repair was 97.4% [CI] [86.5–99.5%] and 98.7% [CI] [92.8–99.8%] respectively, with a range of confidence [CI] of 95%. Our study’s main findings suggest that patients with neck injuries and no vascular, airway, or gastrointestinal soft sign can be safely managed with a conservative approach. It is important to emphasize the value of the clinical examination since there are many contexts in the modern world where a considerable amount of the population is afflicted by neck trauma and treated under conditions where technological resources are limited.

中文翻译：

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临床检查在评估穿透性颈部损伤中的价值：诊断准确性测试的回顾性研究

在资源有限的环境中，有许多高容量的创伤中心，在这里对患者进行全面的临床检查可能有助于确定更经济，更准确且适用范围更广的确定穿透性颈部损伤患者的方法。这项研究的目的是验证彻底的体格检查作为这些患者的可靠诊断工具。我们对诊断准确性测试进行了一项观察性回顾性研究，在该研究中，我们针对每种特定情况（选择性研究，临床观察和手术探查），根据金标准测试将临床发现（患者入院时出现的症状和软迹象）与确定的发现进行了比较）。该研究于2009年8月至2010年6月在肯尼迪医院（HOK）进行。该样本包括207名（n = 207）患者的临床记录，这些患者前往肯尼迪医院（HOK）的急诊室穿透颈部伤口。在总样本中，36.2％（n = 75）的患者被认为是“无症状”的，因为他们没有出现任何轻度的损伤迹象。57％（n = 118）的患者出现血管软性体征，分别有15.9％（n = 33）和21.3％（n = 44）的患者出现气道和上消化道的软性体征。用于确定需要手术修复的任何软体征的灵敏度和阴性预测值（NPV）分别为97.4％[CI] [86.5–99.5％]和​​98.7％[CI] [92.8–99.8％]，范围为置信度[CI]为95％。我们研究的主要发现表明，颈部受伤且无血管，气道，保守的方法可以安全地管理胃肠道或胃肠道软体征。重要的是要强调临床检查的价值，因为在现代世界中有许多情况，其中相当一部分人口受到颈部创伤的困扰，并在技术资源有限的条件下得到治疗。