Skeletal surveys lack efficacy in obtunded polytrauma patients

OBJECTIVES: To evaluate if a skeletal survey protocol initiated after 48 hours of intubation will decrease time to diagnosis and the treatment of occult fractures in the obtunded polytrauma patient. DESIGN: Prospective cohort trial with a retrospective cohort comparison arm. SETTING: A single level 1 trauma center. PATIENTS: Forty-seven patients were identified prospectively for the skeletal survey protocol to screen for occult fractures. The results of the new protocol were compared to a retrospective comparison arm of 46 patients who would have met the same criteria. INTERVENTION: A skeletal survey protocol using 2-view x-rays of the patients’ extremities to evaluate for any occult injuries after 48 hours of intubation in trauma patients with altered mental status and an unreliable tertiary examination. MAIN OUTCOME MEASURE: Time to diagnosis of delayed fractures and surgical intervention from date of admission. RESULTS: The average time to fracture diagnosis and time to surgical intervention in days was not statistically significant between the retrospective and prospective groups [fracture diagnosis: 1.6 ± 5.1 (retrospective) versus 0.5 ± 0.9 (prospective) (P = .159); time to initial surgery: 2.7 ± 5.6 (retrospective) versus 1.1 ± 1.7 (prospective) (P = .064); time to final surgery: 5.3 ± 8.5 (retrospective) versus 2.4 ± 3.0 (prospective) (P = .029)]. In addition, only 24% (4/17) of patients with a delayed fracture diagnosis required surgical intervention making most nonoperative. CONCLUSIONS: Given the inability to have a clinically or statistically significant impact on time to fracture diagnosis or subsequent treatment, we cannot advocate for the routine use of a skeletal survey protocol in obtunded polytrauma patients. Level of Evidence: Level III