How can surgical exploration be performed for penetrating neck injury? A single institutional retrospective study

Purpose Penetrating neck injuries (PNIs) are present in 5–10% of trauma cases, and are associated with high morbidity and mortality, especially when existing injuries are missed. Although some guidelines describe the management of PNI, there is no established strategy on determining whether to proceed with surgery or conservative treatment. We aimed to clarify factors that require surgical intervention in patients with PNI. Methods We retrospectively reviewed patients with PNI who were admitted to our institute between July 2007 and July 2024 and assessed the need for surgery. Patients who experienced cardiopulmonary arrest upon arrival or who had other surgical indications due to severe injuries at other sites were excluded. Patients were divided into two groups according to the need for surgical intervention. We evaluated their characteristics, injury descriptions, vital signs on arrival, and outcomes. Results During the study period, 59 patients with PNI were transported to our hospital. Two with cardiopulmonary arrest on arrival and another five with severe injuries at other sites were excluded. Thus, 52 PNI patients were included in this study. There were more patients with shock index ≥ 1.0 (p = 0.035) and hard sign positivity (p < 0.001) in the operative group. Conclusion For patients with a shock index of ≥ 1.0 on arrival or hard sign positivity, physicians should not hesitate in performing surgical exploration, regardless of the injury to the zone. Furthermore, hemodynamically stable patients with no hard signs should be evaluated by CT angiography with or without esophageal fluoroscopy to decide on surgical intervention.