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The article by Gill et al1 provides further evidence that a log-roll
is not useful for major trauma patients in the primary survey. Even with
a GCS 15 and no influence from alcohol or opiates only 60% of patients
with thoraco-lumbar fractures had tenderness on log-roll. The authors did
not examine how many false negatives were found by examination or the
impact of a distracting injury.
Log-rolling a polytrauma...
Log-rolling a polytrauma patient in the primary survey is potentially
life-threatening if the patient has a site of internal haemorrhage as this
movement may lead to clot disruption and irretrievable exsanguination. The
log-roll causes pain in the presence of injury and provokes anxiety which
may worsen the patient's physiological state. For blunt trauma there is no
evidence that injuries missed by inspection of the back will lead to the
patients demise (although all penetrating trauma will require examination
of the back for occult wounds). Studies have also shown that the log-roll
may induce spinal movement which may be damaging in the presence of
As clinicians at the 3 adult Major Trauma Centres in the West
Midlands we advocate no log roll during the primary survey for a blunt
trauma patient with a mechanism of injury triggering a local major trauma
triage tool. The patient should instead be transferred supine using a
suitable device, such as an orthopaedic scoop stretcher onto a vacuum
mattress or Wolverson transfer mattress. Whilst clinical examination in
the primary survey is important, an immediate CT (from head to pelvis
under the supervision of the trauma team) can rapidly and reliably exclude
life-threatening injuries without examination of the back.
When a senior decision has been made that the patient does not
require a CT scan (or a CT scan has been reported as showing no internal
haemorrhage, visceral injury or pelvic fracture) it is then appropriate to
log-roll the patient to assess the back for further injury.
1. Gill DS, et al. Can initial clinical assessment exclude
thoracolumbar vertebral injury?Emerg Med J 2013;30:679-682
2. Suter RE, Tighe TV, Sartori J, et al. Thoraco-lumbar instability
during variations of the log roll maneuver. Prehospital Disaster Med
3. MacGuire RA, Neville S, Green BA, Watts C. Spinal instability and
the log-rolling maneuver. J Trauma 1987;27:525-31.