Introduction of the “Straight-Leg-Evaluation-Trauma-Test” as a rapid assessment for long-bone fractures in a trauma bay setting

Abstract

PurposeLower extremity long bone fractures can constitute a substantial source of bleeding in the polytraumatized patient and should be diagnosed in the primary survey as fast as possible. Standardized clinical assessment tools for fracture detection in the trauma bay, however, are lacking. We propose the “Straight-Leg-Evaluation-Trauma-Test” (SILENT-test) as a rapid assesment tool for the lower extremity. The aim of this prospective diagnostic study was to evaluate the efficacy of this test in a standardized preclinical setting. MethodsMedical professionals with different levels of experience performed clinical fracture diagnotics in four human cadavers with two femur- and two tibia shaft fractures. The SILENT-test (ST) and conventional fracture testing (CS) were performed. A cross-over design was used and participants were randomly allocated and blinded. Accuracy, subjective clinical applicability, and clinical performance of both tests were measured and compared. ResultsA total of 440 clinical tests were performed by 55 examiners. For femoral fractures, ST had a positive predictive value (PPV) of 0.97 (95% CI 0.93 to 0.99), a specificity of 0.91 (95% CI 0.80 to 0.97) and a sensitivity of 0.96 (95% CI 0.92 to 0.99). CS had a PPV of 0.97 (95% CI 0.93 to 0.99), a specificity of 0.93 (95% CI 0.82 to 0.98) and a sensitivity of 0.89 (95% CI 0.83 to 0.93). ST was significantly more feasible (8.05 ± 1.48 vs. 5.91 ± 2.09) had a significantly greater certainty (8.32 ± 1.84 vs. 7.89 ± 2.01) and was significantly faster (7.73 ± 6.61 vs 14.50 ± 11.11 s). ConclusionPreclinical evaluation of the SILENT-test showed equal accuracy compared to conventional fracture testing, while being significantly faster and significantly more clinically applicable. Prospective diagnostic clinical studies are justified to hopfully improve trauma care. Level of evidenceLevel III.