Can initial clinical assessment exclude thoracolumbar vertebral injury?

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. MAT...

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Autores principales: Gill, Dinendra Singh, Mitra, Biswadev, Reeves, Fairleigh, Cameron, Peter A, Fitzgerald, Mark, Liew, Susan, Varma, Dinesh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717597/
https://www.ncbi.nlm.nih.gov/pubmed/22915226
http://dx.doi.org/10.1136/emermed-2011-201085
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author Gill, Dinendra Singh
Mitra, Biswadev
Reeves, Fairleigh
Cameron, Peter A
Fitzgerald, Mark
Liew, Susan
Varma, Dinesh
author_facet Gill, Dinendra Singh
Mitra, Biswadev
Reeves, Fairleigh
Cameron, Peter A
Fitzgerald, Mark
Liew, Susan
Varma, Dinesh
author_sort Gill, Dinendra Singh
collection PubMed
description 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.
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spelling pubmed-37175972013-07-23 Can initial clinical assessment exclude thoracolumbar vertebral injury? Gill, Dinendra Singh Mitra, Biswadev Reeves, Fairleigh Cameron, Peter A Fitzgerald, Mark Liew, Susan Varma, Dinesh Emerg Med J Original Article 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. BMJ Publishing Group 2013-08 2012-08-22 /pmc/articles/PMC3717597/ /pubmed/22915226 http://dx.doi.org/10.1136/emermed-2011-201085 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/
spellingShingle Original Article
Gill, Dinendra Singh
Mitra, Biswadev
Reeves, Fairleigh
Cameron, Peter A
Fitzgerald, Mark
Liew, Susan
Varma, Dinesh
Can initial clinical assessment exclude thoracolumbar vertebral injury?
title Can initial clinical assessment exclude thoracolumbar vertebral injury?
title_full Can initial clinical assessment exclude thoracolumbar vertebral injury?
title_fullStr Can initial clinical assessment exclude thoracolumbar vertebral injury?
title_full_unstemmed Can initial clinical assessment exclude thoracolumbar vertebral injury?
title_short Can initial clinical assessment exclude thoracolumbar vertebral injury?
title_sort can initial clinical assessment exclude thoracolumbar vertebral injury?
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717597/
https://www.ncbi.nlm.nih.gov/pubmed/22915226
http://dx.doi.org/10.1136/emermed-2011-201085
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