A. Kopatsis1, A. P. Kopatsis2, Y. Patel3, F. Husain3, G. Cornica3, K. E. Kopatsis4, V. Chetram4 1Elmhurst Hospital Center,Surgery,East Elmhurst, NY – NEW YORK, USA 2New York University,Liberal Studies,NEW YORK, NY, USA 3Saint George’s University,Medicine,Grenada, Grenada, Grenada 4George Washington University,Liberal Arts,Washington, DC, USA
Introduction:
Whole-Body CT (WBCT) scans are a quick and reliable method of identifying injuries in the trauma patient. This especially hold true in the intoxicated patient who often cannot provide a reliable history. While WBCT scans are associated with a decreased mortality and hospital stay in patients with a high mechanism of injury, their utility in intoxicated patients following a fall remain unknown. The objective of this study was to evaluate the validity of physical examination to identify injuries in the acutely intoxicated patient when compared to WBCT scan findings.
Methods:
This study is a retrospective review of all intoxicated trauma patients who were found down secondary to a witnessed fall < 20ft, GCS > 8 and not requiring intubation. Documented history and physical examination were compared to imaging findings to evaluate the accuracy of physical examination in identifying internal injuries in the intoxicated patient. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for physical exam when compared to WBCT findings. The chi-squared test was used to evaluate associations between physical exam and CT findings, and the t-test was used to evaluate associations between clinical variables and false-negative physical exam results.
Results:
43 out of 523 intoxicated patients over a 2-year period met the inclusion criteria. All patients had an injury that required admission to the hospital. Of 19 patients with a positive chest CT, 13 had had a negative physical exam, for a physical exam sensitivity of 32%. Of 8 patients with a positive abdominal CT, 6 had had a negative physical exam, for a sensitivity of 16%. No clinical predictors were found to be associated with false negative (vs true negative) physical exam results.
Conclusion:
Intoxicated patients who present as trauma evaluations after a low-level fall can be prone to significant injuries. History is often unreliable in these patients. In our study, physical examination had low validity and missed potential injuries, especially that of the chest when compared to WBCT scans.
