Impact of deferred surgical intervention on the outcome of external laryngeal trauma.

Abstract

External laryngeal trauma (ELT) can be a fatal injury. Proper management of ELT significantly affects patient survival and quality of life. The optimal timing of surgical intervention is controversial. In this study, we review the incidence, management, and outcome of ELT and attempt to analyze the risk factors and prognosis of this injury. We conducted retrospective review using prospective data collection from patients with ELT in a level I trauma center from May 2008 to May 2013. We retrieved data regarding the severity of ELT, Injury Severity Score (ISS), New Injury Severity Score (NISS), Reverse Trauma Score (RTS), surgical timing, intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), long-term outcome, and mortality. We analyzed the risk of prolonged hospitalization, adverse outcome, and mortality. The 48 patients in this cohort had a mean age of 40.8±19.6 years. Twenty-four patients underwent operation within 48 hours, 10 patients underwent operation after 48 hours, and the other 14 patients did not require surgical intervention. A high NISS and the necessity for operation prolonged the ICU LOS and the HLOS. A high ISS and a low RTS predicted mortality. Initial phonatory impairment and the necessity of surgical intervention increased adverse outcomes. In conclusion, ELT leads to high mortality and morbidity. The mortality in our series was related to severe associated injuries and to initial physical decompensation. Proper resuscitation and aggressively physiologic compensation were more important in the initial phase. Deferred treatment was acceptable until the patients were ready for operation.