Holmes et al identified risk factors associated with injury to the thoracolumbar spine following blunt trauma. These can help identify patients who may require imaging studies to look for these lesions and those who do not. The authors are from the University of California at Davis, McMaster University, Oregon Health & Science Center and UCLA.


A patient is at "high risk" for thoracolumbar injury after blunt trauma if 1 or more of the following is present:

(1) The patient complains of pain in the thoracolumbar spine.

(2) Midline palpation of the thoracolumbar spine elicits tenderness.

(3) The patient has an abnormal peripheral neurologic exam.

(4) The patient is intoxicated with drugs and/or alcohol.

(5) The patient has a decreased level of consciousness.

(6) The patient has a distracting painful injury.


A patient with none of these findings does not need radiographs of the spine to exclude thoracolumbar injury. A patient with one or more of the findings will need radiographs but only a small number of patients will have a positive study.



• The criteria had a sensitivity of 100% but a poor specificity (around 4%). The negative predictive value was 100% but positive predictive value of only 7%.


To read more or access our algorithms and calculators, please log in or register.