Prediction of blunt traumatic injury in high-acuity patients: bedside examination vs computed tomography.

Smith CB, Barrett TW, Berger CL, Zhou C, Thurman RJ, Wrenn KD
Am J Emerg Med. 2011 29 (1): 1-10

PMID: 20825767 · DOI:10.1016/j.ajem.2009.05.025

OBJECTIVE - The addition of spiral computed tomography (SCT) to bedside assessment in patients with major trauma may improve detection of significant injury. We hypothesized that in high-acuity trauma patients, emergency physicians' ability to detect significant injuries based solely on bedside assessment would lack the sensitivity needed to exclude serious injuries when compared with SCT.

METHODS - This was a prospective single-cohort study of high-acuity trauma patients routinely undergoing whole-body SCT at a level 1 trauma center from January to September 2006. Before SCT, emergency physicians assigned ratings for likelihood of injury to 5 body regions on the basis of bedside assessment. These ratings were compared with final SCT interpretations.

RESULTS - We enrolled 400 patients as a convenience sample; 71 were excluded. When a "very low" rating was considered negative and "low," "intermediate," "high," and "very high" were considered positive, emergency physicians were able to detect head, cervical spine, chest, abdominal/pelvic, and thoracic/lumbar spine injuries with sensitivities (95% confidence interval) of 100% (98.6%-100%), 97.4% (94.9%-98.8%), 96.9% (94.2%-98.4%), 97.9% (95.5%-99.1%), and 97.0% (94.3%-98.5%), respectively. For overall diagnostic accuracy, areas under the receiver operating characteristics curve (95% confidence interval) were 0.87 (0.82-0.92), 0.71 (0.62-0.81), 0.81 (0.76-0.86), 0.77(0.71-0.83), 0.74 (0.65-0.84), respectively.

CONCLUSIONS - Bedside assessment by emergency physicians before SCT was sensitive in ruling out serious injuries in high-acuity trauma patients with a "very low" rating for injury. However, overall diagnostic accuracy was low, suggesting that SCT should be considered in most high-acuity patients to prevent missing injuries.

Copyright © 2011 Elsevier Inc. All rights reserved.

MeSH Terms (18)

Abdominal Injuries Adult Confidence Intervals Emergency Service, Hospital Female Head Injuries, Closed Humans Male Middle Aged Physical Examination Point-of-Care Systems Prospective Studies ROC Curve Sensitivity and Specificity Spinal Injuries Thoracic Injuries Tomography, Spiral Computed Wounds, Nonpenetrating

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