BG Klinikum Bergmannstrost Halle gGmbH

After structured (S3 guideline, ATLS ® ) acute care of multiple trauma patients in trauma centers, post-acute missed injuries continue to occur with incidence rates ranging from 1.3 to 39% as described in literature. The aim of the tertiary survey was the reduction of these rates. However, high numbers of missed injuries continue to be reported. The aim of this prospective, single-center, blinded clinical diagnostic study was to determine whether the standardised use of 3-phase whole-body skeletal scintigraphy in severely injured patients can reduce the number of missed injuries compared with the established standard procedure for polytrauma diagnosis.

26 patients aged 18 years or older (median 53.5 years, 4 female, 22 male) with an ISS ≥ 9 were evaluated by an orthopaedic and trauma surgeon using skeletal scintigraphy after completion of standardised trauma room diagnostics and tertiary survey, a median of 7 days after trauma. All clinical and diagnostic examinations were then analysed and a final consensus was reached on the bony injuries. An evaluation of each procedure against the consensus was performed for the whole body and five body regions.

Skeletal scintigraphy was clearly superior to the established method (sensitivity 98.8% vs. 75.4%). Of the 60 additional bony injuries identified, 25 were treated without therapeutic consequences. Twenty-nine were treated conservatively without additional immobilisation and five with additional immobilisation. One unnecessary immobilisation was ended and no surgical treatment was required.

Three-phase whole-body skeletal scintigraphy is a low-risk, highly sensitive tool for reducing the incidence of missed injuries. A more liberal indication for skeletal scintigraphy should be given for injuries of increasing severity and in persons with impaired consciousness or paralysis, to avoid sequelae of missed injuries.

The study was registered at the German Clinical Trails Register (DRKS) with the identifier DRKS00029402.

Various treatment strategies for osteoporotic vertebral compression fractures (OVCF) have been proposed, with the OF-score being a promising tool for therapeutic decision-making. The aim of this study is to determine the significance of the individual components of the OF-score for the therapy recommendation. Furthermore, score modifications will be sought that lead to improved agreement between the score recommendation and clinically successful therapy.

Data from the prospective multicenter study "Clinical evaluation of the OF-score for therapy planning and treatment recommendation for osteoporotic fractures of the thoracolumbar spine" (EOFTT) with 518 patients (128 male, 390 female), including 344 surgically and 174 conservatively treated, were used. Binary discriminant analysis and logistic regression models were applied to analyze the predictive power of OF-score variables for the treatment decision. ROC analysis determined the predictive value of VAS pain, with thresholds defined using the Youden index.

A total of 508 patients were analyzed. Binary discriminant analysis showed an explanatory power of 79.7%, and logistic regression showed 80.4%. The most powerful variables were VAS pain (0.809), mobilization (-0.405), and OF classification (0.302). ROC analysis identified a VAS threshold of 5.5 for surgical treatment (AUC = 0.811, p < 0.001). A VAS threshold of ≥ 5 yielded the highest accuracy (71.5%), while thresholds ≥ 4 had the highest sensitivity (71.9%) and ≥ 6 the highest specificity (82.0%).

A modified OF-score with a VAS pain threshold of ≥ 5 improves accuracy and balances specificity and sensitivity. Despite this adjustment, the OF-score's predictive power of 80% remains underutilized. Further research could enhance the clinical utility of the modified score and explore the potential of other variables.