Cumulative soft-sign burden is associated with clinically significant injury in hemodynamically stable penetrating neck trauma
Year: 2026
Type: article
Study design: Observational Study
Abstract: 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.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7220716682