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Background The purpose of this study was to audit our experience with computed tomography angiography (CTA) for the detection of aerodigestive tract injury (ADTI) following penetrating neck injury (PNI) and to assess the significance of deep surgical emphysema on CTA. Methods A prospectively maintained trauma registry at the Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, South Africa was retrospectively interrogated. The data of all patients with PNI investigated with CTA over a 4-y period were reviewed. All findings of deep surgical emphysema were correlated to an aggregate standard of reference for ADTI as demonstrated by results from clinical examination, surgical neck exploration, endoscopy or contrasted swallow to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of this finding. Results A total of 383 patients underwent a CTA for PNI. A total of 94 vascular injuries were identified on 78 positive CTA studies. The sensitivity and specificity of CTA in detecting a vascular injury were 94.4% and 96.7%. Of the 383 patients investigated a total of 38 patients were diagnosed with digestive tract injury (DTI), and all of these patients were found to have deep surgical emphysema on CTA, except for one patient with a clinically insignificant oral cavity injury. Another 126 patients also had deep surgical emphysema on CTA but no DTI. The sensitivity, specificity, PPV, and NPV of deep surgical emphysema for the diagnosis of confirmed DTI in PNI were therefore 97.4%, 63.5%, 22.7%, and 99.5%, respectively. The sensitivity and NPV were, however, 100% when clinically insignificant injuries were excluded. Including patients with confirmed airway injuries and excluding all patients with pneumothoraces yielded a sensitivity, specificity, PPV, and NPV of 94.1%, 71.9%, 30.0%, and 98.9%, respectively, for the identification of ADTI. When excluding surgically irrelevant injuries, the sensitivity and NPV were again both 100%. Conclusions CTA for PNI has a high sensitivity and specificity for demonstrating vascular injury. The absence of deep surgical emphysema in the deep cervical fascial planes virtually excludes surgically significant ADTI. The presence of deep surgical emphysema is nonspecific but warrants further investigation. [ABSTRACT FROM AUTHOR]

Abstract Background This study sought to describe the burden of disease of acute kidney injury (AKI) among adult South African trauma patients who presented to a tertiary level trauma service. Methods The trauma database was interrogated for the period from December 2012 to July 2017. All patients over the age of 18 y, who were admitted following trauma, were included. Outcome data were reviewed. This included in-hospital mortality, need for intensive care unit admission, and length of stay. AKI was defined according to the latest Kidney Disease Improving Global Outcomes guidelines using the presentation serum creatinine. Results A total of 7613 patients were admitted for trauma over the period under review. Four thousand two hundred sixty-six patients were suitable for analysis. A total of 238 (5.6%) patients presented with AKI, 149 (62.6%) had stage 1 AKI, 40 (16.8%) had stage 2 AKI, and 49 (20.6%) had stage 3 AKI. There was a higher incidence of AKI in patients with blunt trauma. The length of stay, need for intensive care unit admission, and mortality were significantly higher in patients presenting with AKI than in those who did not present with AKI. There were 172 deaths (4.0%). The patients who died were older and had significantly higher Injury Severity Score than survivors. They were more acidotic on presentation, had lower Glasgow Coma Scale, and were more likely to be hypotensive on presentation. They also were significantly more likely to have AKI on presentation. (30.2% versus 5.6% P < 0.001). AKI on presentation was an independent risk factor for mortality (odds ratio 3.038 95% confidence interval 1.260-7.325). Conclusions AKI is common in patients presenting to our center with acute trauma. The presence of AKI is associated with increased morbidity and mortality. Efforts must be directed to improving recognition of at-risk patients. Prompt referral and adequate resuscitation of trauma patients before transfer must be prioritized. [ABSTRACT FROM AUTHOR]