Clinical evaluation of the spine in the intoxicated blunt trauma patient

The objective of the current study was to evaluate the accuracy of the clinical examination of the spine following blunt trauma in intoxicated patients. Methods included a retrospective review of all cases of blunt trauma presenting to an urban level I trauma centre over 1 year. Data was analysed separately for the clinical examination of the cervical spine (CS) and for the thoracic and lumbar spine (T + LS). Two hundred and sixteen cases of blunt trauma secondary to MVC (n = 143) or falls (n = 73) were retained for analysis. In intoxicated patients, sensitivities and specificities for CS tenderness were 60.0 and 64.3% (radiological abnormality) and 100 and 68.6% (operative stabilization), respectively. With respect to the T + LS in intoxicated patients; sensitivities and specificities for T + LS tenderness and radiological abnormality were 80.0 and 71.4% and for the ability of the clinical examination to pick up unstable T + LS fractures requiring operative stabilization 100 and 72.0%, respectively. Intoxicated blunt trauma patients may be able to have spine fractures requiring operative stabilization excluded using physical examination of the spine at presentation to the trauma center.