3. Results:
A total of 62 PNIs were identified from February 2019 to April 2021. The
total incidence of recorded PNIs increased by 48.0% post lockdown (n=25
pre-lockdown to n=37 post-lockdown), (see Table 1).
In total, 83.9% of patients were male (n=52) whilst 16.1% were female
(n=10). The mean age for males was 38.8 (range 16 to 89) for females
38.0 (range 7 to 62). There was a modest increase in females being
admitted with PNI from pre to post lockdown (n=3 to n=7 an increase of
133.3%).
In terms of classifying the injuries, the most common zone was Zone II
(43.5% n=27), followed by those occurring in Zone I (17.7% n=11),
Zones II and III simultaneously (13.6% n=9) and Zones I + II (11.3%
n=7), (see Table 3) (2). Overall, incidences of injuries in each zone
remained stable with the exception of Zone 1 which increased (n=3 to n=8
a 166.7% increase).
The most common implement used to inflict injury was a knife (62.9%
n=39) followed by bottle (8.1%, n=5) and gun (6.4%, n=4) and razor
blade (3.2%, n=2). From pre lockdown to post lockdown the use of knives
to inflict PNIs increased (n=15 to n=24 60.0% increase), the use of all
other implements remained stable.
Most PNIs were investigated with a CT scan (75.8%, n=47), Chest X-ray
(CXRs) (n=1) and a number received a CT scan and Chest X-ray (17.7%
n=11). Furthermore, a significant proportion of patients underwent a
CTA/CT with contrast (67.7%, n=42) or using FNE (29.0%, n=18).
Furthermore, many did not have hard signs recorded (61.3%, n=38). In
those who did, the most common were airway compromise (16.1%, n=10),
hypovolaemia (12.9%, n=8), arterial bleeding (11.3%, n=7) and surgical
emphysema (11.3%, n=7). There were broadly no increases in patients
experiencing hard signs but a substantial increase in patients with no
hard signs (n=13 to n=25, 92.3% increase), (see Table 4).
When attempting to prevent blood loss, the use of platelets and
haemostatic agents such as tranexamic acid was frequent (46.8%, n=29)
whilst major haemorrhage protocol (‘code red’) was activated in a
minority, (25.8%, n=16) of cases. There was no change in this before
and after the onset of the pandemic, (see Table 4).
In terms of definitive management, the most common form of management
was delayed exploration and closure under general anaesthetic (59.7%,
n=37), followed by conservative treatment (25.8% n=16) whilst a
minority received immediate surgical management (14.5%, n=9). The most
common procedures recorded were exploration under general anaesthetic
(62.9%, n=39) followed by closure of a neck wound (38.7%, n=24) and
panendoscopy (30.6%, n=19). Other procedures recorded in small numbers
include: panendoscopy, washout, foreign body removal as well as
pharyngoscopy and laryngoscopy. Procedure numbers broadly remained
stable from the pre to the post lockdown period except for delayed
exploration and closure under general anaesthetic increasing from the
pre to post lockdown (n=13 to n=24 84.6% increase).
There were increases in the number of patients undergoing surgical
management from the pre to the post pandemic period including: Washout
(133.3% increase), Pharyngoscopy (100% increase), Exploration (41.2%
increase) Panendoscopy (37.5% increase), (see Table 2).
The most common surgical speciality involved in the treatment of PNIs
alongside Otolaryngology was Plastics (32.5% n=20) followed by Vascular
(22.6%, n=14) and Cardiothoracic (17.7%, n=11). There was an increase
in patients being consulted by Plastics from pre to post pandemic period
(n=6 to n=14 133.3% increase) but numbers of patients being seen by
other specialities remained stable.
An increase in mortality was noted. Before the pandemic, no deaths were
recorded due to PNI, but from March 2020 to April 2021, post-lockdown
there were 3 deaths.