@article{ref1,
title="Computed tomography angiography in the "no zone" approach era for penetrating neck trauma: a systematic review",
journal="Journal of trauma and acute care surgery",
year="2020",
author="Ibraheem, Kareem and Wong, Sunnie and Smith, Alison and Guidry, Chrissy and McGrew, Patrick and McGinness, Clifton and Duchesne, Juan and Taghavi, Sharven and Harris, Charles and Schroll, Rebecca",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Penetrating neck trauma continues to present a diagnostic dilemma. Practice guidelines advocate the use of computed tomography angiography (CTA) for suspected vascular or aero-digestive injuries in all neck zones. There is also an evolving evidence of 'No Zone' approach where the decision to obtain a CTA is guided by physical exam findings and clinical presentation. The aim of this systematic review is to examine existing literature on the diagnostic accuracy of CTA as an integral component of the &quot;no zone&quot; approach in stable patients witt penetrating neck trauma.   METHODS: We performed a systematic review using an electronic search of three databases (PubMed, Medline, Cochrane Review) from 2000-2017.   RESULTS: A total of 5 prospective and 8 retrospective studies were included. The sensitivity of CTA ranged from 83-100%; specificity, 61-100%; positive predictive value, 30-100% and negative predictive value, 90-100%. Three studies reported high sensitivity and specificity for the detection of vascular injuries, but low specificity for aero-digestive tract injuries. When stratified by clinical presentation, CTA had a sensitivity of 89.5-100% and specificity of 61-100% in stable patients presenting with soft signs. In a combined group of stable patients with either hard signs or soft signs, the sensitivity of CTA was 94.4-100% and specificity 96.7-100%. Among patients presenting with hard signs, the sensitivity of CTA was 78.6-90% and specificity is 100%.   CONCLUSIONS: This is the first systematic review to examine the role of computed tomography angiography in penetrating neck trauma. In combination with physical exam, CTA demonstrated a reliable high sensitivity and specificity for detecting injuries in penetrating neck trauma in stable patients with soft signs of injury and select patients with hard signs of injury. These results support the management of penetrating neck trauma using &quot;no zone&quot; approach based on physical examination and the use of CTA in stable patients.   LEVEL OF EVIDENCE: Systematic Review, level IV.<p /> <p>Language: en</p>",
language="en",
issn="2163-0755",
doi="10.1097/TA.0000000000002919",
url="http://dx.doi.org/10.1097/TA.0000000000002919"
}