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

Megha Singh Tevit, Eshana Singh, Alexander Olaussen, Susan Liew, Mark Fitzgerald, Biswadev Mitra

Research output: Contribution to journalArticleResearchpeer-review

5 Citations (Scopus)

Abstract

Background: During assessment after injury, the log roll examination, in particular palpation of the thoracolumbar spine, has low sensitivity for detecting spinal injury. The manoeuvre itself requires a pause during trauma resuscitation. The aim of this study was to assess the utility of the log roll examination in unconscious trauma patients for the diagnosis of soft tissue and thoracolumbar spine injuries.
Methods: A retrospective cohort study was undertaken,reviewing the cases of unconscious (Glasgow Coma Scale (GCS) <9) and/or intubated major trauma (Injury Severity Scale (ISS) >12, abbreviated injury scale 2008) patients from the Alfred Trauma Registry, over a 2-year period from January 2011 to December 2012. Log roll examination findings, as documented in the medical record, were compared with CT reports. Out of the 624 screened records, 222 (35.6%) were excluded as the logroll or CT/MRI had not been performed.
Results: There were a total of 2028 major trauma presentations to the Alfred Hospital Emergency and Trauma Centre during the study period. Excluded cases comprised 147 patients who did not have a documented log roll, and 75 patients who did not have a CT or MRI.Of the 402 cases that met inclusion criteria, 35.3% had a thoracolumbar fracture, and the sensitivity of log roll examination was found to be 27.5%, with a specificity of 91%. The negative likelihood ratio for abnormalities on log roll was low (0.8).
Conclusions: Examination of the back in unconscious trauma patients could be limited to visual inspection only to allow identification of penetrating wounds and other soft tissue injuries (including of the posterior scalp)and removal of foreign bodies, in patients planned for CT scans. The low sensitivity and poor negative likelihood ratio suggest that a normal log roll examination does not accurately predict the absence of bony injury to the thoracolumbar spine.
Original languageEnglish
Pages (from-to)632 - 635
Number of pages4
JournalEmergency Medicine Journal
Volume33
Issue number9
DOIs
Publication statusPublished - 2016

Cite this

@article{1471a61d85f54deb9a0a1331798beb1d,
title = "What is the purpose of log roll examination in the unconscious adult trauma patient during trauma reception?",
abstract = "Background: During assessment after injury, the log roll examination, in particular palpation of the thoracolumbar spine, has low sensitivity for detecting spinal injury. The manoeuvre itself requires a pause during trauma resuscitation. The aim of this study was to assess the utility of the log roll examination in unconscious trauma patients for the diagnosis of soft tissue and thoracolumbar spine injuries.Methods: A retrospective cohort study was undertaken,reviewing the cases of unconscious (Glasgow Coma Scale (GCS) <9) and/or intubated major trauma (Injury Severity Scale (ISS) >12, abbreviated injury scale 2008) patients from the Alfred Trauma Registry, over a 2-year period from January 2011 to December 2012. Log roll examination findings, as documented in the medical record, were compared with CT reports. Out of the 624 screened records, 222 (35.6{\%}) were excluded as the logroll or CT/MRI had not been performed.Results: There were a total of 2028 major trauma presentations to the Alfred Hospital Emergency and Trauma Centre during the study period. Excluded cases comprised 147 patients who did not have a documented log roll, and 75 patients who did not have a CT or MRI.Of the 402 cases that met inclusion criteria, 35.3{\%} had a thoracolumbar fracture, and the sensitivity of log roll examination was found to be 27.5{\%}, with a specificity of 91{\%}. The negative likelihood ratio for abnormalities on log roll was low (0.8).Conclusions: Examination of the back in unconscious trauma patients could be limited to visual inspection only to allow identification of penetrating wounds and other soft tissue injuries (including of the posterior scalp)and removal of foreign bodies, in patients planned for CT scans. The low sensitivity and poor negative likelihood ratio suggest that a normal log roll examination does not accurately predict the absence of bony injury to the thoracolumbar spine.",
author = "{Singh Tevit}, Megha and Eshana Singh and Alexander Olaussen and Susan Liew and Mark Fitzgerald and Biswadev Mitra",
year = "2016",
doi = "10.1136/emermed-2015-205450",
language = "English",
volume = "33",
pages = "632 -- 635",
journal = "Emergency Medicine Journal",
issn = "1472-0205",
publisher = "BMJ Publishing Group Ltd",
number = "9",

}

What is the purpose of log roll examination in the unconscious adult trauma patient during trauma reception? / Singh Tevit, Megha ; Singh, Eshana; Olaussen, Alexander; Liew, Susan; Fitzgerald, Mark; Mitra, Biswadev.

In: Emergency Medicine Journal, Vol. 33, No. 9, 2016, p. 632 - 635.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - What is the purpose of log roll examination in the unconscious adult trauma patient during trauma reception?

AU - Singh Tevit, Megha

AU - Singh, Eshana

AU - Olaussen, Alexander

AU - Liew, Susan

AU - Fitzgerald, Mark

AU - Mitra, Biswadev

PY - 2016

Y1 - 2016

N2 - Background: During assessment after injury, the log roll examination, in particular palpation of the thoracolumbar spine, has low sensitivity for detecting spinal injury. The manoeuvre itself requires a pause during trauma resuscitation. The aim of this study was to assess the utility of the log roll examination in unconscious trauma patients for the diagnosis of soft tissue and thoracolumbar spine injuries.Methods: A retrospective cohort study was undertaken,reviewing the cases of unconscious (Glasgow Coma Scale (GCS) <9) and/or intubated major trauma (Injury Severity Scale (ISS) >12, abbreviated injury scale 2008) patients from the Alfred Trauma Registry, over a 2-year period from January 2011 to December 2012. Log roll examination findings, as documented in the medical record, were compared with CT reports. Out of the 624 screened records, 222 (35.6%) were excluded as the logroll or CT/MRI had not been performed.Results: There were a total of 2028 major trauma presentations to the Alfred Hospital Emergency and Trauma Centre during the study period. Excluded cases comprised 147 patients who did not have a documented log roll, and 75 patients who did not have a CT or MRI.Of the 402 cases that met inclusion criteria, 35.3% had a thoracolumbar fracture, and the sensitivity of log roll examination was found to be 27.5%, with a specificity of 91%. The negative likelihood ratio for abnormalities on log roll was low (0.8).Conclusions: Examination of the back in unconscious trauma patients could be limited to visual inspection only to allow identification of penetrating wounds and other soft tissue injuries (including of the posterior scalp)and removal of foreign bodies, in patients planned for CT scans. The low sensitivity and poor negative likelihood ratio suggest that a normal log roll examination does not accurately predict the absence of bony injury to the thoracolumbar spine.

AB - Background: During assessment after injury, the log roll examination, in particular palpation of the thoracolumbar spine, has low sensitivity for detecting spinal injury. The manoeuvre itself requires a pause during trauma resuscitation. The aim of this study was to assess the utility of the log roll examination in unconscious trauma patients for the diagnosis of soft tissue and thoracolumbar spine injuries.Methods: A retrospective cohort study was undertaken,reviewing the cases of unconscious (Glasgow Coma Scale (GCS) <9) and/or intubated major trauma (Injury Severity Scale (ISS) >12, abbreviated injury scale 2008) patients from the Alfred Trauma Registry, over a 2-year period from January 2011 to December 2012. Log roll examination findings, as documented in the medical record, were compared with CT reports. Out of the 624 screened records, 222 (35.6%) were excluded as the logroll or CT/MRI had not been performed.Results: There were a total of 2028 major trauma presentations to the Alfred Hospital Emergency and Trauma Centre during the study period. Excluded cases comprised 147 patients who did not have a documented log roll, and 75 patients who did not have a CT or MRI.Of the 402 cases that met inclusion criteria, 35.3% had a thoracolumbar fracture, and the sensitivity of log roll examination was found to be 27.5%, with a specificity of 91%. The negative likelihood ratio for abnormalities on log roll was low (0.8).Conclusions: Examination of the back in unconscious trauma patients could be limited to visual inspection only to allow identification of penetrating wounds and other soft tissue injuries (including of the posterior scalp)and removal of foreign bodies, in patients planned for CT scans. The low sensitivity and poor negative likelihood ratio suggest that a normal log roll examination does not accurately predict the absence of bony injury to the thoracolumbar spine.

UR - http://emj.bmj.com.ezproxy.lib.monash.edu.au/content/33/9/632

U2 - 10.1136/emermed-2015-205450

DO - 10.1136/emermed-2015-205450

M3 - Article

VL - 33

SP - 632

EP - 635

JO - Emergency Medicine Journal

JF - Emergency Medicine Journal

SN - 1472-0205

IS - 9

ER -