|Seth Althoff, MD||Einstein Medical Center, Department of Emergency Medicine, Philadelphia, Pennsylvania|
|Ryan Overberger, DO||Einstein Medical Center, Department of Emergency Medicine, Philadelphia, Pennsylvania|
|Mark Sochor, MD, MS||University of Virginia, Department of Emergency Medicine, Charlottesville, Virginia|
|Dipan Bose, PHD||Einstein Medical Center, Department of Emergency Medicine, Philadelphia, Pennsylvania|
|Joshua Werner, DO||World Bank, Transport Specialist, Washington, DC|
West J Emerg Med. 2017 October;18(6):1108–1113
GLASS Clinical Decision Rule Applied to Thoracolumbar Spinal Fractures in Patients Involved in Motor Vehicle Crashes.
Althoff S, Overberger R, Sochor M, Bose D, Werner J
West J Emerg Med. 2018 March;19(2):445. Last two author affiliations symbols incorrect [Dipan Bose, PhD‡; Joshua Werner, DO*]
Introduction: There are established and validated clinical decision tools for cervical spine clearance. Almost all the rules include spinal tenderness on exam as an indication for imaging. Our goal was to apply GLASS, a previously derived clinical decision tool for cervical spine clearance, to thoracolumbar injuries. GLass intact Assures Safe Spine (GLASS) is a simple, objective method to evaluate those patients involved in motor vehicle collisions and determine which are at low risk for thoracolumbar injuries.
Methods: We performed a retrospective cohort study using the National Accident Sampling System-Crashworthiness Data System (NASS-CDS) over an 11-year period (1998–2008). Sampled occupant cases selected in this study included patients age 16–60 who were belt-restrained, front- seat occupants involved in a crash with no airbag deployment, and no glass damage prior to the crash.
Results: We evaluated 14,191 occupants involved in motor vehicle collisions in this analysis. GLASS had a sensitivity of 94.4% (95% CI [86.3–98.4%]), specificity of 54.1% (95% CI [53.2–54.9%]), and negative predictive value of 99.9% (95% CI [99.8–99.9%]) for thoracic injuries, and a sensitivity of 90.3% (95% CI [82.8–95.2%]), specificity of 54.2% (95% CI [53.3–54.9%]), and negative predictive value of 99.9% (95% CI [99.7–99.9%]) for lumbar injuries.
Conclusion: The GLASS rule represents the possibility of a novel, more-objective thoracolumbar spine clearance tool. Prospective evaluation would be required to further evaluate the validity of this clinical decision rule. [West J Emerg Med. 2017;18(6)1108–1113.]
PMCID: PMC5654881 [PubMed – indexed for MEDLINE]
Full text available through open access at http://escholarship.org/uc/uciem_westjem