A critical look at the value of clinical examination in polytraumatized patients

Abstract

Background and question:The Advanced Trauma Life Support (ATLS) offers a concept for the treatment of severely injured patients. In the so-called "primary survey", the patients are first examined clinically by "A-E". Subsequently, a CT scan will be performed to make accurate diagnosis. But what benefit do the clinical examinations have if a CT is performed immediately afterwards? Are the examinations just a waste of time or do they provide important information? Method: Systematic mesh-term research on pubmed.com with 62 studies to compare the latest literature on the value of clinical examinations with ATLS recommendations.Results: Relevant airway problems can directly threaten the patient and should be quickly diagnosed and fixed. Clinical examination of the cervical spine has poor sensitivity and should be avoided. The examination for hemato-/pneumothorax after blunt and penetration trauma shows a middle sensitivity but a good negative and positive predictive value. If a serious thoracic injury is suspected, a thoracic puncture or a chest tube should be done. Internal bleeding is difficult to diagnose clinically and often cannot be treated without surgical or radiological intervention. The CT scan should be done promptly and time delays by numerous clinical examinations should be avoided. Unstable pelvic fractures can be well diagnosed, depending on the technique used. If the pelvis is unstable a pelvic sling should be applied to avoid a "C-problem". Intracranial and spinal injuries cannot be diagnosed clinically. If suspected, a CT scan should be performed. During a prolonged examination of the undressed patient, the body temperature can decrease, which may be accompanied by deterioration in blood coagulation. Conclusion:The extent of the physical examination in the shock room, immediately before the CT scan, should be taken individually. With exception of airway and breathing problems, most diagnoses can only be reliably detected and treated after the CT scan..