Surgical decision-making in self-inflicted, non-ballistic penetrating neck injuries: a single-center retrospective study.

purposePenetrating 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 treatment strategies for PNIs are described in current international guidelines, they do not distinguish between gunshot wounds and stab wounds, or between self-inflicted and assault-related injuries. We aimed to identify factors associated with surgical intervention in patients with self-inflicted neck stab wounds, drawing on Japan’s distinctive epidemiology, where civilian firearm access is strictly regulated, gunshot wounds are rare, and self-harm occurs more frequently than assault.

methodsWe retrospectively reviewed patients with PNI admitted to our institute between July 2007 and July 2024 to assess the need for surgery. The primary outcome was surgical intervention. We examined admission indices associated with that decision. Patients with non-self-inflicted injuries or those requiring surgery for severe injuries elsewhere were excluded. Eligible patients were classified into two groups based on surgical requirement. We analyzed their characteristics, injury descriptions, vital signs on arrival, and outcomes.

resultsAmong 59 patients with PNIs, 12 were excluded, leaving 47 patients for analysis; 18 required operative management and 29 were managed nonoperatively. No pediatric patients were included. Baseline characteristics, including age, sex, psychiatric comorbidities, injury mechanism, and injury zone distribution, did not differ significantly between groups. No patients sustained zone III injuries or had a severe Injury Severity Score (ISS; ≥16). Moderate ISS was significantly associated with operative intervention (p < 0.05). On admission, the operative group had lower systolic blood pressure and higher rates of Shock Index ≥ 1.0 and hard signs (all p < 0.01). Heart rate tended to be higher in the operative group, though not significantly. Contrast-enhanced computed tomography revealed no group difference in extravasation. Operative procedures included repairs of major cervical vessels, the trachea, and the pharynx.

conclusionIn self-inflicted, non-ballistic PNIs, Shock Index ≥ 1.0 on arrival and the presence of hard signs were reliable indicators for surgical intervention. These findings are consistent with existing guidelines originally developed in populations with gunshot wounds, and confirm their applicability in settings where stab wounds predominate and firearm injuries are rare.