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

Abstract 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.