A very interesting paper in this month’s EMJ on the utility of log rolling trauma patients. Why interesting? Well, because I think the evidence for the lack of utility in log rolling has been around for some time and yet it persists in practice.
It’s unclear why, perhaps it’s the big scary guidelines that still suggest that we need to take our unstable trauma patients with potential spinal injuries and then flip them on their side to try and shake off some clot and jiggle the broken bones around a bit. Harsh? Perhaps, but I think all trauma clinicians wil have seen physiological deterioration with poor patient handling.
This paper further provides evidence for safe handling and we should all read and carefully consider our response to the question ‘has the patient been rolled’.
In my practice if I really need to have a look at the back then I’ll raise the patient very carefully by 20 degrees, just enough to put a scoop stretcher in, or to feel for foreign matter or obvious injury. If they are going for CT then nothing else is needed.
Whilst we are at it, let’s challenge the mandatory rectal in trauma. It has a poor sensitivity and specificity and let’s face it. The patient is already having a bad day without you putting a finger in their anus.
With such poor sensitivity it’s not going to stop you from doing further investigations and even if positive you’re still going to do further investigations. I think it’s difficult to justify during the primary survey. For patients undergoing CT then these clinical tests can wait.
Let’s leave the log rolling to these experts.
What is the purpose of log roll examination in the unconscious adult trauma patient during trauma reception? http://emj.bmj.com/content/33/9/632.short?rss=1
SCANCrit on log rolls and rectals. http://www.scancrit.com/2014/04/10/log-roll-finger-bum/
Reasons to omit digital rectal exam in trauma patients: no fingers, no rectum, no useful additional information. http://www.ncbi.nlm.nih.gov/pubmed/16394903
Poor test characteristics for the digital rectal examination in trauma patients. http://www.ncbi.nlm.nih.gov/pubmed/17391807