Cumulative soft-sign burden is associated with clinically significant injury in hemodynamically stable penetrating neck trauma.

BACKGROUND

Risk stratification remains challenging in hemodynamically stable patients with penetrating neck trauma and no hard signs. We evaluated the association between cumulative soft-sign burden and clinically significant injury (CSI) requiring therapeutic intervention.

METHODS

This retrospective cohort study included adults with penetrating neck trauma who were hemodynamically stable, had no hard signs, and underwent cervical computed tomography angiography (CTA). CSI was defined as a vascular or aerodigestive injury requiring therapeutic surgical or endovascular intervention. Soft-sign count was assessed using receiver operating characteristic analysis and logistic regression.

RESULTS

Of 109 patients, 33 (30.3%) had CSI. The median soft-sign count was higher among patients undergoing therapeutic surgery (2 vs. 1; p<0.001). Soft-sign count showed good discrimination for CSI (AUC, 0.81; 95% CI, 0.71-0.90). A threshold of ≥1 soft sign yielded 93.9% sensitivity and a 91.7% negative predictive value, whereas ≥2 soft signs yielded 89.5% specificity and a 73.3% positive predictive value. Each additional soft sign was independently associated with higher odds of CSI (adjusted OR, 4.83; 95% CI, 2.42-9.64; p<0.001). Gunshot mechanism was also strongly associated with CSI (OR, 10.58; 95% CI, 2.68-41.75).

CONCLUSION

Increasing soft-sign burden was strongly associated with CSI. The absence of soft signs reduced but did not eliminate the risk, whereas multiple soft signs identified a higher-risk group. Soft-sign count may support imaging prioritization and early surgical consultation but should not replace CTA.