Validity of physical examination in the thorax and abdomen of intoxicated trauma patients following a fall: An exploratory retrospective review

Abstract

Background Whole-Body Computerized Topography (WBCT) scans can be used to identify injuries related to trauma in intoxicated patients who often cannot provide a reliable history. While WBCT scans are associated with a decreased mortality and hospital stay in patients with a high energy mechanism of injury, their utility in intoxicated patients following a fall remain unclear. The objective of this study was to evaluate the validity of physical examination in the thorax and abdomen to identify injuries in the intoxicated patient following a fall when compared to WBCT scan findings. Methods A retrospective chart review was performed over a two-year period of intoxicated trauma patients who were found down secondary to a witnessed fall <20 ft, GCS > 8 and not requiring intubation. Documented physical examination findings were compared to WBCT results. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. A t-test was used to identify differences between clinical variables of false-negative and true-negative physical examinations. Results A total of 523 intoxicated patients presented to the ED with 43 meeting the inclusion criteria. All patients had an injury that required admission to the hospital. Of 19 patients with a positive chest CT, 13 had a negative physical exam, for sensitivity of 32% and specificity of 96%. Of eight patients with a positive abdominal CT, six had a negative physical exam, sensitivity and specificity were 16% and 98% respectively. No clinical variables were found to be different between falsely negative and true negative physical exam results. Conclusion In the acutely intoxicated trauma patient, physical examination findings of the thorax and abdomen were associated with a low validity, having missed an unacceptably high number of injuries, when compared to WBCT scans.