Background: Penetrating neck injuries in the UK are on the increase and the most common weapon used is a knife. Life threatening vascular and aero-digestive injuries as well as nerve damage are the main concern. A systematic but dynamic protocol for managing such patients is required in order for the best outcomes to be achieved. Some patients will require immediate operative intervention, others may present with less dramatic signs and the correct imaging modality will be necessary to identify potential deep injuries. We present our 3 year experience as a major trauma centre and describe the current management principles in our department.

Methods: A retrospective data collection over 3 years of all the major trauma patients that presented to our emergency department. All patients with a knife related injury and patients who were assaulted, injured accidentally or self-harmed were included. A proforma was used to collect the required data.

Results: Of the 185 patients, assault (80%) was the most common cause of penetrating knife injury followed by self-inflicted (11%) and then accidental (9%). 20 penetrating knife injuries were sustained of which 2 required immediate surgical intervention. Using the Monsons classification for identifying the site of the injury, level 1 was the most common. Only 1 CT angiogram was positive out of 20 performed to identify significant vascular injury.

Conclusion: A locally agreed protocol is essential to manage these patients successfully with a multidisciplinary approach involving radiologists, emergency doctors, maxillofacial, vascular and ENT surgeons is important. Not all patients will require expensive and unnecessary exposure to X-rays and CT scans and a protocol will help to identify such patients. Furthermore, our experience demonstrates that clinical examination can be as sensitive as radiological investigations to identify significant injuries requiring formal surgical intervention.