“Diagnostic accuracy of clinical examination to identify life-and limb-threatening injuries in trauma patients”

How good is the physical examination for finding life threatening stuff in trauma patients?

This study sought to answer this question but the title is somewhat misleading. It should have been a bit longer as below:

Diagnostic accuracy of the single pre-hospital physical examination to identify life and limb threatening injuries performed by a doctor in the field around London, UK without using adjuncts who had no idea they were going to participate in a study and may or may not have collected or written down information as sought by the investigative team.

It’s clear that I was not involved in the peer review process of this paper.

Since the methods employed never really had a hope of answering the research question, I’m not going to go into much details of the paper. Nevertheless, I still think their conclusion is correct! “Clinical examination… has only a moderate ability to detect life and limb threatening injuries.”

Even a broken clock is correct twice a day.

Just to reiterate, this was a retrospective study of a single physical exam. It was performed pre-hospital, possibly in an austere environment with no ultrasound or other adjuncts. The doctor very likely had other significant priorities; i.e. scoop and run. It cannot speak to the utility of serial examinations or those performed a bit later as things evolve.

My fear is someone may pull this paper out of their pocket to suggest that we need to do away with physical exam and perform full body CT scans in all trauma patients. This could likely cause harm, especially in lower risk trauma patients or pediatrics.

 

Covering:

Wohlgermut JM, Marsden ME, Stoner RS, et al. Diagnostic accuracy of clinical examination to identify life- and limb-threatening injuries in trauma patients. Scand J Trauma Resusc Emerg Med. 2023;31:18 [link to free full text article]