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Can initial clinical assessment exclude thoracolumbar vertebral injury?
  1. Dinendra Singh Gill1,
  2. Biswadev Mitra2,3,
  3. Fairleigh Reeves2,
  4. Peter A Cameron2,3,4,
  5. Mark Fitzgerald4,5,
  6. Susan Liew5,6,
  7. Dinesh Varma7
  1. 1Emergency Department, Morriston Hospital, Swansea, UK
  2. 2Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
  3. 3Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
  4. 4National Trauma Research Institute, Melbourne, Australia
  5. 5Trauma Service, The Alfred Hospital, Melbourne, Australia
  6. 6Department of Surgery, Monash University, Melbourne, Australia
  7. 7Department of Radiology, The Alfred Hospital, Melbourne, Australia
  1. Correspondence to Dr Dinendra Singh Gill, Emergency Department, Morriston Hospital (ABM University Health Board), Heol Maes Eglwys, Morriston, Swansea SA6 6NL, UK; dinendra.gill{at}wales.nhs.uk or dsg741{at}gmail.com

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.

  • spinal
  • fractures and dislocations
  • wounds

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