SELECTIVE INDICATIONS FOR THORACIC AND LUMBAR RADIOGRAPHY IN BLUNT TRAUMA

Study objective: To determine indications for thoracolumbar radiograph y. Design: Case series with prospective data collection. Setting: Leve l I trauma center. Participants: Blunt-trauma victims more than 12 yea rs old who underwent routine thoracic and lumbar radigraphy according to institutional protocol. Patients were classified as group 1, not ab le to be evaluated clinically (Glasgow Coma Scale score of less than 1 3, intoxication, intubation, or cervical neurologic deficit); and grou p 2, able to be evaluated clinically. Results: Twenty-four of 319 pati ents sustained 25 thoracic or lumbar fractures. Seven of 136 group 1 p atients and 17 of 183 group 2 patients had fractures. Eight of 17 pati ents with pain and 9 of 17 with tenderness had fractures (P=.001). No group 2 patients without pain, tenderness, thoracic or lumbar neuro-de ficit, or major distracting injury, including cervical fracture, had f ractures. The negative predictive value of pain and tenderness was 95% . Five of 46 patients with spinal fractures at any level had multiple fractures. Conclusion: Blunt-trauma victims who cannot be evaluated cl inically should undergo thoracolumbar radiography. Routine radiography may be unnecessary in asymptomatic patients who can be evaluated clin ically and who do not have neurologic deficits or distracting injuries . Spinal fracture at any level mandates complete spinal radiogrphy.