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. 2013 Aug;30(8):679-82.
doi: 10.1136/emermed-2011-201085. Epub 2012 Aug 22.

Can initial clinical assessment exclude thoracolumbar vertebral injury?

Dinendra Singh Gill  1 , Biswadev Mitra, Fairleigh Reeves, Peter A Cameron, Mark Fitzgerald, Susan Liew, Dinesh Varma
Affiliations
Free PMC article

Can initial clinical assessment exclude thoracolumbar vertebral injury?

Dinendra Singh Gill et al. Emerg Med J. 2013 Aug.
Free PMC article

Abstract

Introduction: The aim of this study was to test the hypothesis that all blunt trauma patients, presenting with a Glasgow coma scale (GCS) score of 15, without intoxication or neurological deficit, and no pain or tenderness on log-roll can have any thoracolumbar fracture excluded without imaging.

Materials and methods: All patients diagnosed with a thoracolumbar fracture presenting to the emergency department of a major trauma centre and having an initial GCS score of 15 were included in the study. Variables collected included type of fracture, mechanism of injury, the presence of pain or tenderness on log-roll, ethanol levels and prehospital opioid analgesia.

Results: There were 536 patients with thoracolumbar fractures, of which 508 (94.8%) patients had either pain, tenderness or had received prehospital opioid analgesia. A small subgroup of 28 (5.2%) patients who received no prehospital opioid analgesia, did not complain of pain and had no tenderness to the thoracolumbar spine elicited on log-roll. This subgroup was significantly older (p=0.033) and a high proportion of patients (64.3%) had a concurrent fracture of the cervical spine. Within this subgroup, a clinically significant unstable thoracic fracture was present in three patients, with all three patients exhibiting symptoms and signs of neurological injury or having a concurrent cervical vertebral fracture.

Conclusions: In this population of blunt trauma patients with a GCS score of 15, not under the influence of alcohol or prehospital morphine administration, the absence of pain or tenderness on log-roll can exclude a clinically significant lumbar vertebral fracture, but does not exclude a thoracic fracture.

Keywords: fractures and dislocations; spinal; wounds.

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Figures

Figure 1
Figure 1
Inclusions and exclusions. GCS, Glasgow coma scale score.
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References

    1. Saboe LA, Reid DC, Davis LA, et al. Spine trauma and associated injuries. J Trauma 1991;31:43–9 - PubMed
    1. Cooper C, Dunham C, Rodriguez A. Fall and major injuries are risk factors for thoracolumbar fractures: cognitive impairment and multiple injuries impede the detection of back pain and tenderness. J Trauma 1995;38:692–6 - PubMed
    1. Durham RM, Luchtefeld WB, Wibbenmeyer L, et al. Evaluation of the thoracic and lumbar spine after blunt trauma. Am J Surg 1995;170:681–5 - PubMed
    1. Meldon SW, Moettus LN. Thoracolumbar spine fractures: clinical presentation and the effect of altered sensorium and major injury. J Trauma 1995;39:1110–14 - PubMed
    1. Sava J, Williams MD, Kennedy S, et al. Thoracolumbar fracture in blunt trauma: is clinical exam enough for awake patients? J Trauma 2006;61:168–71 - PubMed

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