Clinical Examination is Highly Sensitive for Detecting Clinically Significant Spinal Injuries after Gunshot Wounds

Rapid assessment of spinal injury in penetrating trauma patients is an important step in the management of these potentially seriously injured patients. In an urban, academic medical center, 282 adult patients with penetrating injury were enrolled over a 6-month period. These patients had a standardized physical examination of their spine using a checklist in an attempt to prospectively determine the sensitivity and specificity of a structured clinical examination to evaluate for spinal injury after penetrating trauma. Of the 282 patients, 139 sustained a stab wound and none of these patients had a spinal injury. Of the remaining 143 gunshot wound (GSW) patients, 112 were deemed evaluable (Glasgow Coma Scale score of 15, not intoxicated, with no distracting injury) and underwent a standardized examination including palpation for pain or deformity and complete neurologic examination. All patients were also evaluated with computed tomography (CT) scans with spinal reconstructions. Clinical signs of pain or neurologic deficit were present in 17.1% of these patients, and of those with positive signs, 46.2% had a spinal injury. Additionally, 3 total patients had spinal injury not detected by clinical examination, but all 3 were transverse or spinous process fractures and did not require surgical intervention or orthotic stabilization. Thus, the overall sensitivity, specificity, positive predictive value, and negative predictive value were 66.7%, 89.6%, 46.2%, and 95.2%, respectively. However, for clinically significant injuries, the sensitivity of clinical examination was 100.0%, specificity 87.5%, positive predictive value 30.8%, and negative predictive value 87.5%.