Traumatic neck injury comprises approximately 5-10% of all traumatic injuries. Despite its low incidence, the number of mortalities due to neck injury is still high. Anatomical features such as the trachea, esophagus, great vessels, and nerves are crowded in small spaces and are relatively unprotected. Therefore, mandatory surgery is generally performed in cases of zone II injury, according to the classification of the anatomical zones of the neck; zone I spans from the clavicles to the cricoid, zone II spans from cricoid to the angle of the mandible, and zone III ranges from the angle of the mandible to the base of the skull. This approach is referred to as the zone-based algorithm and is a traditional assessment for  traumatic neck injury. Routine neck exploration in hemodynamically stable patients leads to a high rate of negative exploration, longer hospital stay, and an increased rate of complications, such as surgical site infection and sepsis. Therefore the management of neck injuries has changed from mandatory exploration of all wounds that penetrate the platysma to an increasingly selective approach, based on patient symptoms. The selective surgery is based on a “no zone” approach, which is to determine the direction of treatment by classifying the symptoms that can be caused by damage to the major vascular, digestive, and respiratory systems. If the patients are hemodynamically unstable or the hard signs are confirmed, surgery is performed without examination. Otherwise, the procedures are performed. 
The purpose of this study was to confirm the usefulness of the “no zone” approach in traumatic neck injuries. We hypothesized that hard signs in symptomatic approaches may be useful for predicting internal organ injuries in the neck.

Cohort/Group Label

traumatic neck injury patients

Cohort/Group Description

Identify predictors of internal organ injury of neck by comparing groups with and without internal organ injury

Cohort/Group Label

traumatic neck injury patients who underwent surgery

Cohort/Group Description

Identify predictors of internal organ injury of neck by comparing groups with and without internal organ injury in patients who underwent surgery

: DNA Collect & Archive: Sample without DNA

hemoglobin, lactate, prothrombin time international normal ratio(PT-INR)

Between January 2014 and December 2018, we prospectively enrolled patients with neck injuries who were treated at the Level I Trauma Center of Wonju Severance Christian Hospital and whose data were part of the Korea Trauma Data Bank (KTDB).

Extraction of patients with diagnosis of traumatic neck injury in KTDB(Korean trauma data base)
The purposive sampling was used as the non-probability extraction (non-probability extraction).

Gender

Age

Description

Between January 2014 and December 2018, we prospectively enrolled patients with neck injuries who were treated at the Level I Trauma Center of Wonju Severance Christian Hospital and whose data were part of the Korea Trauma Data Bank (KTDB).

patients with only contusion of neck or whiplash syndrome were excluded

internal organs injuries (airway, vessels, nerve, digestive, thyroid and hyoid bone) of neck according to clinical signs (hard signs, soft signs, asymptomatic)

Confirmation of clinical features(hard signs, soft signs, asymptomatic) upon arrival at the emergency room, and injuries to major organs in the neck (airway, vessels, nerve, digestive, thyroid and hyoid bone) after CT or surgery

Internal organs injuries (airway, vessels, nerve, digestive, thyroid and hyoid bone) of neck according to anatomical neck zone (zone I, II, III)

Confirmation of anatomical zone (zone I, II, III) upon arrival at the emergency room, and injuries to major organs in the neck (airway, vessels, nerve, digestive, thyroid and hyoid bone) after CT or surgery