INDICATIONS FOR OBTAINING SURVEILLANCE THORACIC AND LUMBAR SPINE RADIOGRAPHS

The purpose of this study was to identify risk factors for thoracic/lu mbar spine fractures in patients with blunt injuries and subsequently establish indications for obtaining surveillance thoracolumbar radiogr aphs. Retrospective review of all patients with blunt injuries (n = 14 85) admitted in 1992 to a level I trauma center with a discharge diagn osis of thoracolumbar spine fracture established entrance criteria for a 4-month prospective study. Relative risk of fracture (RR) was calcu lated. Retrospective. Seventy-six percent (176 of 233) had radiographs ; 21% had fractures; one diagnosed late. Prospective. One hundred perc ent (167 of 167) had radiographs; 9% (15 of 167) had fractures; none d iagnosed late or missed. Forty percent (26 of 65) of patients with fra ctures had no pain or tenderness; 35% (9) required surgical spinal fix ation. Our data define these indications for obtaining thoracolumbar r adiographs in patients with blunt injuries: back pain (RR1), fall grea ter-than-or-equal-to 10 feet, ejection from motorcycle/motor vehicle c rash greater-than-or-equal-to 50 mph, GCS score less-than-or-equal-to 8, (all RR2), and neurologic deficit (RR10). The sensitivity of our su rveillance radiography protocol has increased to 100%. The absence of back pain does not exclude significant thoracolumbar trauma.