title: Clinical examination is highly sensitive for detecting clinically significant spinal injuries after gunshot wounds.
abstract: BACKGROUND
  The optimal method for spinal evaluation after penetrating trauma is currently unknown. The goal of this study was to determine the sensitivity and specificity of a standardized clinical examination for the detection of spinal injuries after penetrating trauma.
  
  
  METHODS
  After Institutional Review Board approval, all evaluable penetrating trauma patients aged 15 years or more admitted to the Los Angeles County + University of Southern California Medical Center were prospectively evaluated for spinal pain, tenderness to palpation, deformity, and neurologic deficit.
  
  
  RESULTS
  During the 6-month study period, 282 patients were admitted after sustaining a penetrating injury; 143 (50.7%) as a result of gunshot wound (GSW) and 139 (49.3%) as a result of stab wound (SW). None of the patients sustaining a SW had a spinal injury. Of the 112 evaluable GSW patients, 9 sustained an injury: 6 with a true-positive and 3 with a false-negative clinical examination. The overall sensitivity, specificity, positive predictive value, and negative predictive value were 66.7%, 89.6%, 46.2% and 95.2%, respectively. For clinically significant injuries requiring surgical intervention, cervical or thoracolumbar spine orthosis, or cord transections, however, the sensitivity of clinical examination was 100.0%, specificity 87.5%, positive predictive value 30.8%, and negative predictive value 87.5%.
  
  
  CONCLUSIONS
  Clinically significant spinal injury, although rare after SWs, is not uncommon after GSWs. A structured clinical examination of the spine in evaluable patients who have sustained a GSW is highly reliable for identifying those with clinically significant injuries.
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, Los Angeles County Medical Center, University of Southern California, Los Angeles, California 90033, USA. kinaba@surgery.usc.edu
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.forename: David
authors.initials: D
authors.lastname: Ibrahim
authors.forename: Bernardino C
authors.initials: BC
authors.lastname: Branco
authors.forename: Peter
authors.initials: P
authors.lastname: Gruen
authors.forename: Sravanthi
authors.initials: S
authors.lastname: Reddy
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013124:Spinal Injuries / Q000175:diagnosis* / Q000209:etiology; D036542:Tomography, Spiral Computed; D014948:Wounds, Gunshot / Q000150:complications* / Q000175:diagnosis; D014951:Wounds, Stab / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult