Abstract
Background
Thoracolumbar (TL) injury is a common finding in the severely injured multi-trauma
patient. However, the incidence and pattern of TL injury in patients with milder trauma
is unclear.
Objective
The aim of this study was to collect and analyze evidence for the development of a
clinical decision rule (CDR) to evaluate the TL spine in patients with non-severe
blunt trauma and avoid dedicated imaging in low-risk cases.
Methods
Adult patients with blunt trauma who presented to a major academic center (May 2016
to October 2017) and received dedicated imaging of the TL spine were included. Exclusion
criteria consisted of any coexisting condition preventing the acquisition of history
or examination. The primary endpoint is TL spine injury requiring orthopedic evaluation,
bracing/orthosis, or surgery. Preliminary CDR derivation was performed with recursive
partitioning.
Results
Of 4612 patients screened, 1049 (22.7%) met inclusion criteria. Thirty-six (3.4%)
patients were found to have TL spine injury, of which 88.9% received spinal bracing,
orthosis, or surgery. Absence of midline tenderness conveyed the highest negative
predictive value, followed by a non-severe mechanism of injury, lack of neurologic
examination findings, and age < 65 years. No patients in this cohort with these four
findings had a TL spine injury.
Conclusions
In certain lower-risk blunt trauma patients < 65 years of age, focused examination
combined with mechanism of injury may be highly sensitive (100%) to rule out TL injury
without the need for dedicated imaging. However, validation is necessary, given multiple
study limitations. Potential instrument to screen for TL injury in minor trauma: TL
injury is unlikely if all four of the following are present: 1) no midline back tenderness
or deformity, 2) no focal neurologic signs or symptoms or altered mentation, 3) age
< 65 years; and 4) lack of severe mechanism of injury, for example, fall greater than
standing, motor-vehicle collision with rollover/ejection/pedestrian or unenclosed
vehicle, and assault with a weapon.
Keywords
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Article info
Publication history
Published online: August 09, 2019
Accepted:
June 8,
2019
Received in revised form:
May 8,
2019
Received:
February 1,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
