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Peer-reviewedCC BY-NCUlusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES

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

  • Hamdi Haluk Cali1
  • Muzaffer Akkoca2
  • Sibel Alicura Tokgoz3
  • Ilker Sirin1
  • Ozlem Akkoca4
  • Furkan Yılmaz5
  • Ayse Hicret Cali6
  • Ismail Borazan1
6 affiliations
  1. 1Department of Emergency Medicine, Ministry of Health Ankara Etlik City Hospital, Ankara-Türkiye.
  2. 2Department of General Surgery, Ministry of Health Ankara Etlik City Hospital, Ankara-Türkiye.
  3. 3Department of Otolaryngology, Ministry of Health Ankara Etlik City Hospital, Ankara-Türkiye.
  4. 4Department of Otolaryngology, Ministry of Health Ankara Bilkent City Hospital, Ankara-Türkiye.
  5. 5Department of Emergency Medicine, Ministry of Health Ankara Bilkent City Hospital, Ankara-Türkiye.
  6. 6Department of Emergency Medicine, Ministry of Health Ankara Gülhane Training And Research Hospital, Ankara-Türkiye.
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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.

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Cite

BibTeXRIS
BibTeX
@article{cali2026cumulative,
  title = {{Cumulative soft-sign burden is associated with clinically significant injury in hemodynamically stable penetrating neck trauma.}},
  author = {Hamdi Haluk Cali and Muzaffer Akkoca and Sibel Alicura Tokgoz and Ilker Sirin and Ozlem Akkoca and Furkan Yılmaz and Ayse Hicret Cali and Ismail Borazan},
  journal = {Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma \& emergency surgery : TJTES},
  year = {2026},
  month = oct,
  doi = {10.14744/tjtes.2026.49290},
  url = {https://europepmc.org/article/MED/42841902},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Cumulative soft-sign burden is associated with clinically significant injury in hemodynamically stable penetrating neck trauma.
AU  - Hamdi Haluk Cali
AU  - Muzaffer Akkoca
AU  - Sibel Alicura Tokgoz
AU  - Ilker Sirin
AU  - Ozlem Akkoca
AU  - Furkan Yılmaz
AU  - Ayse Hicret Cali
AU  - Ismail Borazan
PY  - 2026
DA  - 2026/10/01
JO  - Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES
DO  - 10.14744/tjtes.2026.49290
UR  - https://europepmc.org/article/MED/42841902
AB  - 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.
SN  - 1306-696X
SN  - 1307-7945
ER  -