title: Clinical evaluation of the spine in the intoxicated blunt trauma patient.
abstract: The objective of the current study was to evaluate the accuracy of the clinical examination of the spine following blunt trauma in intoxicated patients. Methods included a retrospective review of all cases of blunt trauma presenting to an urban level I trauma centre over 1 year. Data was analysed separately for the clinical examination of the cervical spine (CS) and for the thoracic and lumbar spine (T + LS). Two hundred and sixteen cases of blunt trauma secondary to MVC (n = 143) or falls (n = 73) were retained for analysis. In intoxicated patients, sensitivities and specificities for CS tenderness were 60.0 and 64.3% (radiological abnormality) and 100 and 68.6% (operative stabilization), respectively. With respect to the T + LS in intoxicated patients; sensitivities and specificities for T + LS tenderness and radiological abnormality were 80.0 and 71.4% and for the ability of the clinical examination to pick up unstable T + LS fractures requiring operative stabilization 100 and 72.0%, respectively. Intoxicated blunt trauma patients may be able to have spine fractures requiring operative stabilization excluded using physical examination of the spine at presentation to the trauma center.
authors.affiliation: Montreal General Hospital, Department of Surgery, McGill University Health Center, Montreal, Que., Canada H3G 1A4. moishe.liberman@mail.mcgill.ca
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
authors.forename: Nadia
authors.initials: N
authors.lastname: Farooki
authors.forename: Andre
authors.initials: A
authors.lastname: Lavoie
authors.forename: David S
authors.initials: DS
authors.lastname: Mulder
authors.forename: John S
authors.initials: JS
authors.lastname: Sampalis
mesh_terms: D000435:Alcoholic Intoxication / Q000150:complications*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D010808:Physical Examination / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000209:etiology / Q000601:surgery