Journal Basic Info
- Impact Factor: 1.989**
- H-Index: 6
- ISSN: 2637-4625
- DOI: 10.25107/2637-4625
Major Scope
- Urological Surgery
- Minimal Invasive Surgery
- Podiatric Surgery
- Colorectal Surgery
- Trauma Surgery
- Surgery & Surgical Research
- Neurological Surgery
- Hand Surgery
Abstract
Citation: World J Surg Surg Res. 2021;4(1):1303.DOI: 10.25107/2637-4625.1303
Physical Examination is Inadequate to Rule Out Thoracolumbar Spine Injuries in a Rural Trauma Center
Scha’Chia Murphy1, Rosemary Paine2, Carolyne Falank2, Julianne Ontengco2, Forest Sheppard2 and Damien W Carter2*
1Department of Surgery, University of Washington, Seattle, USA
2Department of Surgery, Maine Medical Center, USA
*Correspondance to: Damien W Carter
PDF Full Text Research Article | Open Access
Abstract:
Introduction: In the conscious, alert and unaltered trauma patient, clinical examination to rule out
Thoracolumbar (TL) spine fractures is common in U.S. trauma centers. Purpose of this study was to
assess the effectiveness of the initial trauma bay examination for diagnosing TL spine injuries after
blunt trauma in an ACS verified level I trauma center.
Methods: Retrospective chart review was performed to include blunt trauma patients who sustained
TL spine injuries diagnosed by CT scan in between January 2016 to December 2017. Determination
of whether the initial physical exam indicated a potential injury to the TL spine. Patients who had
a GCS <15, injury diagnosed at an outside hospital prior to transfer or where no trauma team
evaluation were excluded.
Results: Of 223 patients with TL spine injuries, 140 patients were excluded, and the 83 patients with
a TL spine injury, 47 (57%) had an initial trauma clinical exam that positively indicated an injury.
Among the 36 subjects with TL spine injury and a negative physical exam, 58.3% had a clinically
significant fracture requiring an intervention (orthotic brace or surgery). Three subjects (8.3%) with
a negative clinical exam underwent operative treatment.
Conclusion: Physical examination as a basis for ruling out TL spine injury in the evaluable blunt
trauma patient is inadequate. More than half of the patients with negative clinical exams were
subsequently found to have a significant injury requiring intervention. In order to avoid overuse of
CT screening, there may be a role for routine X-ray imaging in this cohort.
Keywords:
Spine; Injury; Thoracolumbar; CT screening; Physical exam
Cite the Article:
Scha’Chia Murphy, Paine R, Falank C, Ontengco J, Sheppard F, Carter DW. Physical Examination is Inadequate to
Rule Out Thoracolumbar Spine Injuries in a Rural Trauma Center. World J Surg Surgical Res. 2021; 4: 1303..