A novel assessment tool for detecting injuries of the lower extremities in trauma bay patients: The "Straight-Leg-Evaluation-Trauma-Test" (SILENT)

Introduction

Rapid and precise assessment of relevant injuries is essential in the initial treatment of severely injured patients in the trauma bay. We present a concise novel technique for the rapid and safe evaluation of a novel test for detecting shaft fractures of the lower extremity

Methods

First, the test was assessed in a cadaver study. Cadavers had different types of injuries (femoral shaft, tibial shaft, both fractures) and one served as control. Examiners were blinded to the injuries and performed their routine test and the novel test.

In a second step this novel test was introduced in the clinical setting. Treating trauma surgeons applied the test in all consecutive patients in the trauma bay and documented their results. These clinical results were then compared with the radiographic assessment.

In a final step a survey has been performed that included all trauma surgeons who had some experience with the novel test assessing reliability, safety, and recommendations.

Results

The cadaver study yielded a positive predictive value of 0.97 (95% CI 0.93 to 0.99) with highest sensitivity and specificity for detecting tibia shaft fractures. In the clinical setting, the overall sensitivity for the SILENT was 5% (95%CI 64 to 84%), and overall specificity was 99% (95%CI 97 to 100%). Highest sensitivity was for detection of tibia fractures (93%, 95%CI 77 to 99%). Sensitivity of SILENT was higher in the unconscious patient (96%, 95%CI 78 to 100%) with a near 100% specificity.

The survey yielded comparable safety with increased standardization of the assessment procedure when compared with the conventional testing.

Conclusion

The SILENT appears to be a rapid, safe and secure alternative to conventional testing. Radiographic evaluation based on positive SILENT is highly recommended.

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