Anterior-posterior view by full-body digital X-ray to rule out severe spinal injuries in Polytraumatized patients.

Häckel, Sonja; Hofmann, Elena; Anwander, Helen; Albers, Christoph E.; Basedow, Jasmin; Bigdon, Sebastian F.; Exadaktylos, Aristomenis K.; Keel, Marius J B; Dunn, Robert N; Maqungo, Sithombo; Benneker, Lorin M.; Held, Michael; Hoppe, Sven (2021). Anterior-posterior view by full-body digital X-ray to rule out severe spinal injuries in Polytraumatized patients. BMC emergency medicine, 21(1), p. 27. BioMed Central 10.1186/s12873-021-00419-1

[img]
Preview
Text
s12873-021-00419-1.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (1MB) | Preview

BACKGROUND

Spinal injuries are present in 16-31% of polytraumatized patients. Rapid identification of spinal injuries requiring immobilization or operative treatment is essential. The Lodox-Statscan (LS) has evolved into a promising time-saving diagnostic tool to diagnose life-threatening injuries with an anterior-posterior (AP)-full-body digital X-ray.

METHODS

We aimed to analyze the diagnostic accuracy and the interrater reliability of AP-LS to detect spinal injuries in polytraumatized patients. Therefore, within 3 years, AP-LS of polytraumatized patients (ISS ≥ 16) were retrospectively analyzed by three independent observers. The sensitivity and specificity of correct diagnosis with AP-LS compared to CT scan were calculated. The diagnostic accuracy was evaluated by using the area under the ROC (receiver operating characteristic curve) for sensitivity and specificity. Interrater reliability between the three observers was calculated using Fleiss' Kappa. The sensitivity of AP-LS was further analyzed by the severity of spinal injuries.

RESULTS

The study group included 320 patients (48.5 years ±19.5, 89 women). On CT scan, 207 patients presented with a spinal injury (65%, total of 332 injuries). AP-LS had a low sensitivity of 9% (31 of 332, range 0-24%) and high specificity of 99% (range 98-100%). The sensitivity was highest for thoracic spinal injuries (14%). The interrater reliability was slight (κ = 0.02; 95% CI: 0.00, 0.03). Potentially unstable spinal injuries were more likely to be detected than stable injuries (sensitivity 18 and 6%, respectively).

CONCLUSION

This study demonstrated high specificity with low sensitivity of AP-LS in detecting spinal injuries compared to CT scan. In polytraumatized patients, AP-LS, implemented in the Advanced Trauma Life Support-algorithm, is a helpful tool to diagnose life-threatening injuries. However, if spinal injuries are suspected, performing a full-body CT scan is necessary for correct diagnosis.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center

UniBE Contributor:

Häckel, Sonja, Anwander, Helen, Albers, Christoph E., Bigdon, Sebastian, Exadaktylos, Aristomenis, Benneker, Lorin Michael, Hoppe, Sven

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1471-227X

Publisher:

BioMed Central

Language:

English

Submitter:

Andrea Stettler

Date Deposited:

29 Mar 2021 14:09

Last Modified:

05 Dec 2022 15:50

Publisher DOI:

10.1186/s12873-021-00419-1

PubMed ID:

33663394

Uncontrolled Keywords:

Diagnostic accuracy Full-body digital X-ray LODOX-Statscan Radiography Spinal injuries

BORIS DOI:

10.48350/154926

URI:

https://boris.unibe.ch/id/eprint/154926

Actions (login required)

Edit item Edit item
Provide Feedback