Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging

Hsu, Jeremy; Joseph, Tony; Ellis, Andrew

doi:10.1016/s0020-1383(02)00368-6

Cited by 139 publications

(89 citation statements)

References 20 publications

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“…Abnormal neurological signs were significant in two studies [29,35], but not in others [28,34,36]. Clinician judgment, based on a positive or equivocal clinical exam (LRþ 5 2.9, LRÀ 5 0.00 [32]), was significant in one of the two studies that Eligible studies for data extraction n = 12…”

Section: Index Test Resultsmentioning

confidence: 94%

“…Pain and tenderness were assessed by numerous studies either as individual items or in combination. When assessed individually, the results were contradictory across studies [31,34], but when used in combination were effective in raising or lowering the suspicion of vertebral fracture (LRþ 5 7.2, 6.7 [35,38]; LRÀ 5 0.42, 0.44 [35,38]). The presence of muscle spasm or back bruising was not significant.…”

Section: Index Test Resultsmentioning

confidence: 99%

“…Some studies only reported results for the diagnostic accuracy of the clinical features in those patients who were evaluated with the reference standard, and excluded those patients who were not [28,32,36,38]. All studies used x-ray as the reference standard for detecting vertebral fracture, although some included the use of additional imaging procedures, for example, computed tomography [35,37,39].…”

Section: Study Characteristicsmentioning

confidence: 99%

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A systematic review identifies five “red flags” to screen for vertebral fracture in patients with low back pain

Henschke

Maher

Refshauge

2008

Journal of Clinical Epidemiology

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Section: Index Test Resultsmentioning

confidence: 94%

Section: Index Test Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

A systematic review identifies five “red flags” to screen for vertebral fracture in patients with low back pain

Henschke

Maher

Refshauge

2008

Journal of Clinical Epidemiology

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“…The positive predictive value was 6.6% the negative predictive value and sensitivity was 90-100% [1,2]. According to a study performed by Gonzalez [3] sensitivity of symptoms listed above is 91% for injuries of the cervical spine.…”

Section: Clinicalmentioning

confidence: 97%

Operative Timing and Management of Spinal Injuries in Multiply Injured Patients

Hierholzer

Bühren²,

Woltmann

2007

Eur J Trauma Emerg Surg

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Spinal injuries occurring in polytrauma patients are caused by high impact trauma. Due to high velocity mechanism, trauma of the vertebral column may be accompanied by injuries of adjacent body cavities such as thorax, abdomen, and pelvis. Neurologic examination is mandatory and has to be documented preferably using the ASIA/IMSOP-classification. Clinical symptoms may point towards spinal injury. However, absence of clinical symptoms is not sufficient to rule out spinal injuries. Two diagnostic pathways may be followed to assess the spine: (1) Conventional X-ray diagnostics of the entire spine followed by selective CT scanning of suspected lesions and CT scanning of the upper cervical spine region C0-C3 in unconscious patients. (2) Whole body polytrauma-multislice-spiral-CT scanning from head to pelvis without conventional Xray playing the key role in the algorithm of modern ER management. In this study, 287 polytrauma patients with associated spinal injuries were analyzed prospectively from a cohort group of 731 polytrauma patients treated from 2002 to 2004 in our institution. Indications for surgery include neurologic deficit, instability, as well as malalignment and dislocation. In polytraumatized patients, indication for primary surgery is given in complex spinal injuries with associated vascular, neurologic, or organ injuries as well as multilevel spinal fractures or unstable spinal injuries. In patients with unstable spinal injuries cardio-pulmonary instability and life threatening intracranial pressure are contra - indications for immediate spinal surgery. On the day of injury ventral spondylodesis of unstable cervical spine fractures of C3-C7 and dorsal spondylodesis of unstable thoraco-lumbar fractures using internal fixator are the standard procedures. Polytrauma patients benefit from early stabilization of spinal fractures including reduction of ventilation and ICU treatment, pneumonia rate, general complications, as well as hospital stay. However, it is controversial if mortality rate and neurologic outcome are affected by the time point of operative stabilization.

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“…Cooper and colleagues stated that the incidence of thoracolumbar spinal fracture can be as high as 50% in blunt traumas (Cooper et al 1995). Hsu and colleagues proposed radio imaging of the thoracolumbar spine in all victims of high impact accidents in the presence of midline tenderness, local signs of thoracolumbar injury, abnormal neurological signs, cervical spine fracture, GCS < 15, major distracting injury, and alcohol or drug intoxication (Hsu et al 2003).…”

Section: Introductionmentioning

confidence: 99%

A Case of Missed Thoracic Fracture Masquerading as Intra-Abdominal Injury

Amin¹,

Muhamad²,

Ab³

2017

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ABSTRAK ABSTRACTAltered mental status in the setting of polytrauma poses a challenge to the emergency team managing the patient. The tendency to miss positive findings in these circumstances increases several folds due to multiple factors such as depressed mental status/intoxication, presence of distracting injuries and concurrent life-threatening injuries that require more urgent attention. In view of this, NEXUS (National Emergency X-Radiography Utilization Study) criteria of clearing the cervical spine was adopted and used worldwide. Consensus on clearance of the 128 Med & Health Jun 2017;12(1): 127-130 Amin O. et al. other parts of spine is still lacking. This case reports highlights the findings in a 18-yrs-old male who presented with altered mental status, facial pain and abrasion, following a motor vehicle accident. Facial bone fracture was diagnosed and he was discharged. Three days later, he came with severe epigastric pain. Tenderness on palpation was noted at the spine and Computed Tomography (CT) scan was done. Multiple thoracic vertebra fractures were seen. As a conclusion, thorough primary and secondary survey should be done in patients who have regained full consciousness prior to discharge in order to avoid overlooking other serious injuries.

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Thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging

Cited by 139 publications

References 20 publications

A systematic review identifies five “red flags” to screen for vertebral fracture in patients with low back pain

A systematic review identifies five “red flags” to screen for vertebral fracture in patients with low back pain

Operative Timing and Management of Spinal Injuries in Multiply Injured Patients

A Case of Missed Thoracic Fracture Masquerading as Intra-Abdominal Injury

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