Selective Indications for Thoracic and Lumbar Radiography in Blunt Trauma

Study objective: To determine indications for thoracolumbar radiography. Design: Case series with prospective data collection. Setting: Level I trauma center. Participants: Blunt-trauma victims more than 12 years old who underwent routine thoracic and lumbar radigraphy according to institutional protocol. Patients were classified as group 1, not able to be evaluated clinically (Glasgow Coma Scale score of less than 13, intoxication, intubation, or cervical neurologic deficit); and group 2, able to be evaluated clinically. Results: Twenty-four of 319 patients sustained 25 thoracic or lumbar fractures. Seven of 136 group 1 patients and 17 of 183 group 2 patients had fractures. Eight of 17 patients with pain and 9 of 17 with tenderness had fractures (P =.001). No group 2 patients without pain, tenderness, thoracic or lumbar neurodeficit, or major distracting injury, including cervical fracture, had fractures. 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 clinically should undergo thoracolumbar radiography. Routine radiography may be unnecessary in asymptomatic patients who can be evaluated clinically and who do not have neurologic deficits or distracting injuries. Spinal fracture at any level mandates complete spinal radiography. [Terregino CA, Ross SE, Lipinski MF, Foreman J, Hughes R: Selective indications for thoracic and lumbar radiography in blunt trauma. Ann Emerg Med August 1995;26:126-129.].