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• W2891640763 abstract "Thoracolumbar (TL) injury is a common finding in the multi-trauma patient. However, the incidence and pattern of TL injury in milder trauma patients, typically seen in the average emergency department setting, is unclear. The aim of this study is to develop a clinical decision rule (CDR) to evaluate the TL-spine in non-severe blunt trauma patients and avoid dedicated imaging in low-risk cases. Ideally the rule would be both sensitive and simple to use. Blunt trauma patients aged 18 years and older who presented to a major academic center (May 2016 to October 2017) and received at least dedicated imaging of the thoracic, lumbosacral or thoracolumbar spine were included. Exclusion criteria consisted of pre-activation of the surgical trauma team (criteria: Table 1) or any coexisting condition preventing the acquisition of history or examination. The primary endpoint is TL-spine injury requiring orthopedic evaluation, bracing/orthosis, or surgery. CDR derivation is performed with classification and random forest selection, optimizing for sensitivity. Of 4,612 blunt trauma patients screened, 1,121 (24.3%) met inclusion criteria (mean age 46.1 years [range: 18-100]); 21.8% underwent CT or MRI and the remaining plain film only. Thirty-six patients (3.2%) were found to have TL-spine injury, of which 88.9% received spinal bracing, orthosis, or surgery. Over 95% of included patients complained of back pain (97.1% sensitive for TL injury). Aside from back pain, midline tenderness was the next most sensitive finding, followed by a concerning mechanism of injury (MoI), neurological exam findings, and distracting injury (Table 2). These latter 4 findings have 100% sensitivity (57.8% specificity) in identifying TL-spine injury. In certain trauma patients without multiple severe injuries, focused examination combined with MoI may be highly sensitive (100%) to rule out thoracolumbar injury without the need for dedicated imaging.Table 1Surgical trauma team pre-activation criteriaAny one of:Or any two of:Loss of airway or hypotensionAge > 65GCS < 12 or paralysisUnstable vital signsMultiple long bone fracturesFall > 10ft, ejection/rollover MVC Open table in a new tab Table 2Clinical Decision Rule to screen for thoracolumbar injuryDedicated thoracolumbar imaging indicated for ANY of the following:1)Midline back tenderness or deformity2)Any focal neurological signs or symptoms3)Age > 654)Mechanism of Injury (MoI): fall greater than standing, MVC with rollover/ejection/pedestrian or unenclosed vehicle, assault with a weapon Open table in a new tab" @default.
• W2891640763 created "2018-09-27" @default.
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• W2891640763 date "2018-10-01" @default.
• W2891640763 modified "2023-09-26" @default.
• W2891640763 title "257 A Clinical Decision Rule to Screen Out Thoracolumbar Injury in the Emergency Department" @default.
• W2891640763 doi "https://doi.org/10.1016/j.annemergmed.2018.08.262" @default.
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