Structured Clinical Exam Detects Spinal Injury After Penetrating Trauma

A validated clinical decision rule does not exist for evaluation of the cervical and thoracolumbar spine in patients with stab or gunshot wounds. Researchers at a single level I trauma center prospectively evaluated the sensitivity and specificity of a standardized structured clinical examination of the spine for detecting clinically significant spinal injuries in patients with penetrating trauma who were deemed evaluable (Glasgow Coma Scale score 15, no intoxication, no distracting injury).

Examiners used a standardized checklist to evaluate patients' spines for deformities and tenderness. The cervical spine was evaluated according to NEXUS criteria; patients were log-rolled for evaluation of the thoracolumbar spine. After the structured ex…