@article{ref1,
title="External signs of trauma: a poor predictor of injury in found down and ground level falls",
journal="American journal of surgery",
year="2020",
author="Foster, Shannon Marie and Muller, Alison and Jones, Pamela and Engle, Laura and Sherwood, Alicia and Geng, Thomas A. and Ong, Adrian W.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: The significance of external signs (EST) and signs or symptoms of trauma (SS) after ground level falls or found down (GLF/FD) is unclear. We hypothesized that EST and SS were associated with injury.   METHODS: Patients with GLF/FD were retrospectively studied. SS was defined as having any EST, tenderness, or subjective complaint. Outcomes were any significant finding (SF) and Injury Severity Score (ISS) > 8. Diagnostic accuracy of EST and SS were assessed with positive and negative likelihood ratios (LR+, LR-).   RESULTS: Of 578 patients, 66% and 95% had EST and SS respectively. For EST, LR+ and LR-were 1.14 and 0.76 (SF), and 1.21 and 0.64 (ISS>8). For SS, LR+ and LR-were 1.07 and 0.19 (SF), and 1.03 and 0.49 (ISS>8).   CONCLUSION: EST lacked sufficient diagnostic accuracy for SF and ISS>8. Lack of SS was reasonably accurate in ruling out SF but not ISS>8. Triage utilizing EST alone for GLF/FD is not useful.<p /> <p>Language: en</p>",
language="en",
issn="0002-9610",
doi="10.1016/j.amjsurg.2020.06.046",
url="http://dx.doi.org/10.1016/j.amjsurg.2020.06.046"
}