Diagnostic Value of Clinical Findings in Evaluation of Thoracolumbar Blunt Traumas
Introduction:Â Necessity of imaging for symptom-free conscious patients presented to emergency department (ED) following traumatic thoracolumbar spine injuries has been a matter of debate. The present study was aimed to evaluate the diagnostic value of clinical findings in prediction of traumatic th...
Main Authors: | , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Shahid Beheshti University of Medical Sciences
2018-12-01
|
Series: | Archives of Academic Emergency Medicine |
Subjects: | |
Online Access: | https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/235 |
_version_ | 1811323451226456064 |
---|---|
author | Ali Shahrami Majid Shojaee Seyed Mohammadreza Tabatabaee Elaheh Mianehsaz |
author_facet | Ali Shahrami Majid Shojaee Seyed Mohammadreza Tabatabaee Elaheh Mianehsaz |
author_sort | Ali Shahrami |
collection | DOAJ |
description | Introduction: Necessity of imaging for symptom-free conscious patients presented to emergency department (ED) following traumatic thoracolumbar spine injuries has been a matter of debate. The present study was aimed to evaluate the diagnostic value of clinical findings in prediction of traumatic thoracolumbar injuries compared tocomputed tomography (CT) scan. Methods: The present diagnostic value study was carried out using non-random convenience sampling during the time between October 2013 and March 2014. All trauma patients > 15 years old underwent thoracolumbar CT scan were included. Correlation between clinical and CT findings was measured using SPSS 21.0 and screening performance characteristics of clinical findings in prediction of thoracolumbar fracture were calculated. Results: 169 patients with mean age of 37.8 ± 17.3 years (rage: 15-86) were evaluated (69.8% male). All fracture patients had at least 1 positive finding in history and physical examination. The fracture was confirmed in only 24.6% of the patients with positive findings in history or physical examination. In 37.5% of patients the location of fracture, matched the area of positive physical examinations. Sensitivity, specificity, PPV, NPV, PLR, and NLR of clinical findings in comparison to thoracolumbar CT scan were 100 (95% CI: 89 - 100), 1.5 (95% CI: 0.2-6), 24.5 (95% CI: 18.3-31.9), 100 (95% CI: 19.7-100), 32.5 (95% CI: 24.6-43.03), and infinite, respectively. Conclusion: The results of the present study, show the excellent screening performance characteristics of clinical findings in prediction of traumatic thoracolumbar fracture (100% sensitivity). It could be concluded that in conscious patients with stable hemodynamic, who have no distracting pain and are not intoxicated, probability of thoracolumbar fracture is very low and near to zero in case of no positive clinical finding. |
first_indexed | 2024-04-13T13:54:24Z |
format | Article |
id | doaj.art-4fb713817c5a44969c3e440eff122547 |
institution | Directory Open Access Journal |
issn | 2645-4904 |
language | English |
last_indexed | 2024-04-13T13:54:24Z |
publishDate | 2018-12-01 |
publisher | Shahid Beheshti University of Medical Sciences |
record_format | Article |
series | Archives of Academic Emergency Medicine |
spelling | doaj.art-4fb713817c5a44969c3e440eff1225472022-12-22T02:44:14ZengShahid Beheshti University of Medical SciencesArchives of Academic Emergency Medicine2645-49042018-12-014310.22037/aaem.v4i3.235Diagnostic Value of Clinical Findings in Evaluation of Thoracolumbar Blunt TraumasAli Shahrami0Majid Shojaee1Seyed Mohammadreza Tabatabaee2Elaheh Mianehsaz3Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Emergency Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Clinical Research Support Center, Kashan University of Medical Sciences, Kashan, Iran.Introduction: Necessity of imaging for symptom-free conscious patients presented to emergency department (ED) following traumatic thoracolumbar spine injuries has been a matter of debate. The present study was aimed to evaluate the diagnostic value of clinical findings in prediction of traumatic thoracolumbar injuries compared tocomputed tomography (CT) scan. Methods: The present diagnostic value study was carried out using non-random convenience sampling during the time between October 2013 and March 2014. All trauma patients > 15 years old underwent thoracolumbar CT scan were included. Correlation between clinical and CT findings was measured using SPSS 21.0 and screening performance characteristics of clinical findings in prediction of thoracolumbar fracture were calculated. Results: 169 patients with mean age of 37.8 ± 17.3 years (rage: 15-86) were evaluated (69.8% male). All fracture patients had at least 1 positive finding in history and physical examination. The fracture was confirmed in only 24.6% of the patients with positive findings in history or physical examination. In 37.5% of patients the location of fracture, matched the area of positive physical examinations. Sensitivity, specificity, PPV, NPV, PLR, and NLR of clinical findings in comparison to thoracolumbar CT scan were 100 (95% CI: 89 - 100), 1.5 (95% CI: 0.2-6), 24.5 (95% CI: 18.3-31.9), 100 (95% CI: 19.7-100), 32.5 (95% CI: 24.6-43.03), and infinite, respectively. Conclusion: The results of the present study, show the excellent screening performance characteristics of clinical findings in prediction of traumatic thoracolumbar fracture (100% sensitivity). It could be concluded that in conscious patients with stable hemodynamic, who have no distracting pain and are not intoxicated, probability of thoracolumbar fracture is very low and near to zero in case of no positive clinical finding.https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/235Spinal fracturesPhysical examinationTomographyX-ray computedSigns and symptoms |
spellingShingle | Ali Shahrami Majid Shojaee Seyed Mohammadreza Tabatabaee Elaheh Mianehsaz Diagnostic Value of Clinical Findings in Evaluation of Thoracolumbar Blunt Traumas Archives of Academic Emergency Medicine Spinal fractures Physical examination Tomography X-ray computed Signs and symptoms |
title | Diagnostic Value of Clinical Findings in Evaluation of Thoracolumbar Blunt Traumas |
title_full | Diagnostic Value of Clinical Findings in Evaluation of Thoracolumbar Blunt Traumas |
title_fullStr | Diagnostic Value of Clinical Findings in Evaluation of Thoracolumbar Blunt Traumas |
title_full_unstemmed | Diagnostic Value of Clinical Findings in Evaluation of Thoracolumbar Blunt Traumas |
title_short | Diagnostic Value of Clinical Findings in Evaluation of Thoracolumbar Blunt Traumas |
title_sort | diagnostic value of clinical findings in evaluation of thoracolumbar blunt traumas |
topic | Spinal fractures Physical examination Tomography X-ray computed Signs and symptoms |
url | https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/235 |
work_keys_str_mv | AT alishahrami diagnosticvalueofclinicalfindingsinevaluationofthoracolumbarblunttraumas AT majidshojaee diagnosticvalueofclinicalfindingsinevaluationofthoracolumbarblunttraumas AT seyedmohammadrezatabatabaee diagnosticvalueofclinicalfindingsinevaluationofthoracolumbarblunttraumas AT elahehmianehsaz diagnosticvalueofclinicalfindingsinevaluationofthoracolumbarblunttraumas |