Monday, 31 July 2017

What is the purpose of log roll examination in the unconscious adult trauma patient?

I often wonder what we are trying to accomplish by performing log roll examination in patients with trauma. Will our magical fingers exclude spinal fractures?

Ok, I’ll acknowledge it clearly is useful in penetrating trauma, finding wounds, and foreign bodies. (Interestingly, the most interesting foreign body I ever found was a sawed-off shotgun. But this is another story…)

This retrospective cohort study conducted at the Alfred Hospital aimed to assess the utility of the log roll examination in unconscious (GCS <8) trauma patients for the diagnosis of soft tissue and thoracolumbar spine injury.

Examination findings as documented in the medical record were compared to the CT and/or MRI reports.

The had 402 cases that met inclusion criteria with 35% having thoracolumbar fracture. Yes, quite a banged-up cohort.

The sensitivity of log roll?

27%

Specificity was found to be reasonable at 91%. The log-roll also found soft tissue injury, open wounds, burns and glass but no firearms.

Of course, there are several issues with this paper. The retrospective data charted in the medical record was likely incomplete. There was only a single data abstractor not blinded to the study intentions and a few other problems.

But I’m willing to believe the conclusions.

“Where CT is available, we recommend examination during log roll be limited to visual inspection only, in unconscious trauma patients.”

Some might argue… well, what’s the harm? Fair enough, but palpating is clearly a waste of time in a cohort getting CT anyway.

So, you’ll have to find another place to stick those magical fingers... Just sayin'
   

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