Clinical evaluation of the spine in the intoxicated blunt trauma patient

Liberman, Moïshe; Farooki, Nadia; Lavoie, André; Mulder, David S.; Sampalis, John S.

doi:10.1016/j.injury.2004.09.033

Cited by 8 publications

(10 citation statements)

References 30 publications

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“…Seventeen studies were chosen for detailed appraisal 1,6–10,12,22–30,31 . Six studies examined the indications for TL imaging in blunt trauma patients, 8,23–27 four studies assessed the value of CE in TL fracture detection, 6,7,22,30 six studies examined factors leading to missed or delayed diagnoses of TL spinal injuries 1,9,10,12,28,31 and one study assessed the impact of distracting injuries on spinal fracture detection 29 . Six studies were conducted prospectively, 10,22,24,25,27,29 all were observational and eight were cohort studies 8,22–26,29,30 .…”

Section: Resultsmentioning

confidence: 99%

“…Sava et al. questioned the value of CE for the assessment of traumatic TL fracture 22 . In their study, 20% of TL fractures occurred in patients who had no signs or symptoms of their injury.…”

Section: Resultsmentioning

confidence: 99%

“…In a retrospective study, Liberman et al. assessed the impact of intoxication on CE for spinal injuries 30 . The presence of back tenderness was a more sensitive predictor of TL fracture in patients with a GCS = 15 (sensitivity 90%, negative predictive value (NPV) 80%) than in intoxicated patients (sensitivity 80%, NPV 83%) or in those with GCS 13–14 (sensitivity 78%, NPV 82%).…”

Section: Resultsmentioning

confidence: 99%

“…In addition, the value of CE for identifying TL injury decreased with LOC, 6–8,12,22,23,30 intoxication 6,22,30 and in the presence of other distracting injuries 6–8,22,29 …”

Section: Resultsmentioning

confidence: 99%

“…These concur with our findings that TL screening is not warranted in asymptomatic patients with normal mentation, normal CE and without distracting injury. In contrast to these guidelines, our literature search identified six additional studies to support our recommendations, 1,9,10,22,29,30 and we have proposed clear definitions for our screening criteria to minimize ambiguity in their interpretation.…”

Section: Discussionmentioning

confidence: 99%

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Review article: Indications for thoracolumbar imaging in blunt trauma patients: A review of current literature

O’Connor¹,

Walsham

2009

Emerg Medicine Australasia

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Thoracolumbar spine injury is a common complication of blunt multitrauma and up to one third of fractures are associated with spinal cord dysfunction. Delayed fracture diagnosis increases the risk of neurological complications. While validated screening guidelines exist for traumatic c-spine injury equivalent guidelines for thoracolumbar screening are lacking. We conducted a literature review evaluating studies of thoracolumbar injury in trauma patients to generate indications for thoracolumbar imaging.We performed MEDLINE and Pubmed searches using MeSH terms "Wounds, Nonpenetrating", "Spinal Fractures", "Spinal Injuries" and "Diagnostic Errors", MeSH/subheading terms "Thoracic Vertebrae/injuries" and "Lumbar Vertebrae/injuries" and keyword search terms "thoracolumbar fractures", "thoracolumbar injuries", "thoracolumbar trauma", "missed diagnoses" and "delayed diagnoses". Limits and inclusion criteria were defined prior to searching.We evaluated 16 articles; 5 prospective observational studies (1 cohort study) and 11 retrospective observational studies. Predictors of TL injury in prospective studies -highrisk injury mechanism, distracting injury, impaired cognition, symptoms/signs of vertebral fracture and known cervical fracture -were defined and used to construct a decision algorithm, which in a total of 14189 trauma patients from all eligible studies recommended TL screening in 856(99.1%) of 864 patients with TL fractures and would probably have directed TL imaging in the remaining 8 patients.There is limited low level evidence guiding surveillance TL imaging in adult blunt trauma patients. Despite this, we propose and evaluate an algorithm with a high negative predictive value for TL fractures. This should be incorporated into spinal injury assessment protocols.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…In addition, the value of CE for identifying TL injury decreased with LOC, 6–8,12,22,23,30 intoxication 6,22,30 and in the presence of other distracting injuries 6–8,22,29 …”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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