Airway Management for Penetrating Head and Neck Trauma, Experience of a Trauma Center from 2012 to 2020

BackgroundFrom a series of penetrating head and neck trauma managed in a level-1 Trauma Center, the main aim of this study was to determine predictive factors for early definitive airway management, during pre-hospital time or in the emergency room. The secondary objective was to perform a descriptive epidemiological analysis of the series.MethodsA single-center retrospective study was conducted between January 1 2012 and June 30 2020. in a French Level 1 Trauma Center. The patients included were adults treated for penetrating head and neck trauma, regardless of the mechanism and the causal agent.Results 56 patients were included. Ballistic origin, Shock Index >0.9 and active bleeding in the emergency room were predictive criteria for definitive airway management during pre-hospital time or in the emergency room. 78.6% of patients were male. Median age was 54 years. The trauma followed a suicide attempt in 50% of cases, an accident in 26.7% and an assault in 23.2%, with use of a knife in 42.9% and firearm in 26.8%. Mortality was 10.7%. 16.1% of patients had undergone pre-hospital intubation and 19.1% intubation in the emergency room. CT scan was performed in 87.5% of cases, surgery in 96.4% and tracheotomy in 37.5%. A laryngotracheal lesion was seen in 14.2%. In 50% of patients, primary admission was to intensive care. Conclusions Ballistic origin, Shock Index >0.9 and active bleeding in the emergency room were predictive criteria for early definitive airway management. This study established the profile of patients suffering from penetrating head and neck trauma managed in a Trauma Center over a period of 9 years.

Thyroid Storm in Head and Neck Emergency Patients

Background: Thyroid storm is a rare but life-threatening emergency that prompts urgent intervention to halt its potentially disastrous outcomes. There is not much literature available on thyroid storm in head neck trauma and non-thyroid/parathyroid head neck surgery. Due to rarity of thyroid storm in head and neck trauma/surgery patients, its diagnosis becomes challenging, is often misdiagnosed and causes delay in the diagnosis and management. Therefore, the aim of this work was to compile, analyze and present details to develop a consensus and augment available literature on thyroid storm in this group of patients. Materials and methods: A comprehensive literature search of the last 30 years was performed on PUBMED/MEDLINE, EMBASE, CINAHL and Science Citation Index for thyroid storm using MeSH words and statistical analyses were performed. Results: Seven articles describing seven cases of thyroid storm were reviewed. All patients required medical management and one patient (14.3%) required adjunctive surgical management. Burch and Wartofsky Diagnostic criteria for thyroid storm were used in diagnosis of 42% patients. Time of diagnosis varied from immediately upon presentation to formulating a retrospective diagnosis of having a full-blown thyroid storm at 4 days post presentation. It was misdiagnosed and unthought of initially in majority of these cases, (71.4%) were not diagnosed in the first day of hospital stay. Conclusion: Early recognition of thyroid storm in head and neck patients markedly reduce morbidity/mortality. Albeit unexpected, it should be ruled out in any symptomatic head and neck trauma or post-surgery patient.

Head and Neck Trauma in a Rapidly Growing African Metropolis: A Two-Year Audit of Hospital Admissions

Understanding injury-related burdens is an essential part of trauma quality improvement programs aimed at decreasing morbidity and mortality. This is especially the case in low and middle-income country settings where data on injuries remains limited. The aim of this study was to audit the types of head and neck injuries, which have been diagnosed among patients admitted to a major national hospital in the context of a rapidly growing sub Saharan city. Data were collected retrospectively for head and neck trauma from the Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania from the years 2016 and 2017. Distribution of ICD-10 codes by age and sex for the five most common diagnoses were determined using frequencies and percentages. The most common diagnosis was ICD-10-S02 (fracture of skull and facial bones) with 277 cases (44.1%), which was followed by S05 (injury of the eye and orbit), 114 cases (18.2%), and S09 (other and unspecified injuries of head) 77 cases (12.3%). The mean ages of admission for these three diagnoses were 28.1 (SD: 11.6), 23.8 (SD: 18.9), and 30.8 (SD: 18.0) years, respectively. This study provides information on the overall burden of head and neck trauma at a major regional tertiary care facility. It provides an initial understanding of the burden of head and neck trauma and suggests follow-up in the form of clarification of injury mechanisms and contextual factors for future work.