DELAYED DIAGNOSIS OF THORACOLUMBAR FRACTURES IN MULTIPLE-TRAUMA PATIENTS

Objectives: To determine the frequency of delayed diagnosis of major t horacolumbar vertebral fractures (T-L Fxs) in ED multiple-trauma patie nts, and to determine the differences between cases of delayed and non delayed diagnoses of T-L Fx. Methods: A retrospective chart, review wa s conducted of 181 trauma patients with 310 major T-L Fxs (compression , burst, or chance Fxs or dislocations), Data collected included the t ime of the diagnosis of T-L Fx, the patient's clinical presentation in the ED, the mechanism of injury, and the outcome. Results: Of tile 18 1 patients with major T-L Fxs, 138 were diagnosed in the ED (nondelaye d group), and 43 were diagnosed after the patient left tile ED (delaye d group), Of these, 33 cases occurred in unstable patients requiring e mergent medical imaging and/or operation, 7 occurred when emergency ph ysicians failed to detect subtle compression Fxs on ED radiographs, an d 3 occurred in stable patients who were not radiographed in the ED. T he delayed group were more often critical, and hypotensive, and had lo wer Glasgow Coma Scale (GCS) scores than did the nondelayed group. The delayed group patients also hail mure cervical spine il?juries, multi ple noncontiguous spinal Fxs, high-energy mechanisms of injury, and di rect blunt assaults to the back than did tile nondelayed group patient s. There were 13 patients with T-L Fxs, GCS scores = 15, and normal ba ck examinations. There were 43 patients who had neurologic deficits as sociated with their injuries: 11 patients with incomplete curd lesions progressed, including 3 in the delayed group. Conclusions: A delay in the diagnosis of T-L Fx in hospitalized trauma patients is frequently associated with an unstable patient condition that necessitates highe r-priority procedures than ED T-L. spine radiographs. Such patients sh ould receive spinal precautions until more complete evaluation can be performed. The decision to selectively radiograph T-L spines in multip le-trauma patients should consider the mechanism of injury, the presen ce of possible confounders to physical examination, and clinical signs and symptoms of back injury.