daiki shiba, n/a
fellow
St.luke's international hospital
chuo-ku, Tokyo, Japan
Disclosure information not submitted.
Toru Hifumi, n/a
MD, PhD
St. Luke’s International Hospital, Japan
Disclosure information not submitted.
Title: Traumatic retropharyngeal hematoma without spinal cord injury or spinal fracture
Introduction: Retropharyngeal hematoma is a life-threatening condition due to progressive upper airway obstruction and is frequently accompanied by various events, including cervical spinal cord injury and trauma with or without bone injury. However, only a few case reports have been published to date. Retropharyngeal hematoma commonly occurs after spinal cord injury or spinal fracture, with clinical courses and outcomes determined by primary injuries; however, its natural clinical courses remain unclear. Therefore, this study aimed to determine clinical features of traumatic retropharyngeal hematoma without spinal cord injury or spinal fracture (TREWISS).
Methods: A multicenter retrospective analysis was performed on patients who presented to the emergency department, showing soft-tissue swelling of retropharyngeal space by neck computed tomography (CT) scan from April 2010 to 2020. The inclusion criterion was retropharyngeal space thickness of >7 mm at C1-C4 or >22 mm at C5-C7 based on CT scan. The exclusion criteria were (1) age < 18 years, (2) cardiopulmonary arrest, (3) other causes of soft-tissue swelling besides hematoma, and (4) patients with cervical spinal cord injury or spine fracture. Baseline characteristics were compared using the Wilcoxon test for continuous variables and the chi-square test for binary and categorical variables using JMP (version 16) statistical software.
Results: A total of 23 patients were included in the analysis, and 16 of them needed intubation. The median patient age was 69 years, and 83% of patients were men. Antiplatelet or anticoagulant medications were administered to 26% of patients. The width of hematoma in sagittal CT image was significantly wider in the intubated group (2.8 cm [2.0–3.35] vs. 1.2 cm [0.9–1.7]; p = 0.002). Among the intubated patients, tracheostomy was performed in 53% of patients with median illness duration, mechanical ventilation duration, and days of illness on endotracheal tube removal of 3, 4, and 28 days, respectively.
Conclusions: TREWISS can occur even in patients not taking antiplatelet or anticoagulant medications. Tracheostomy was performed in half of the intubated patients and duration of endotracheal tube placement was about a month.