• Tucker Lurie, Bradford Schwartz, Daniel Najafali, Priyanka Gandhi, Matthew Jackson, and Quincy K Tran.
• University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; The Research Associate Program in Emergency Medicine & Critical Care, University of Maryland School of Medicine, Baltimore, MD; 22 South Greene Street, suite P1G01, Baltimore, MD 21201, USA. Electronic address: Tucker.lurie@som.umaryland.edu.
• Am J Emerg Med. 2020 Oct 1; 38 (10): 2049-2054.

ObjectiveIt remains unclear whether clinicians can rely on specific symptoms and signs to detect or exclude serious head and spinal injury sustained during near-shore aquatic activities. Our study investigated patients' history of present illness (HPI) and physical examination (PE) for their utility in detecting serious head and spinal injury.MethodsWe conducted a multicenter retrospective comparative analysis of adult patients who were transported from the beach in Ocean City, Maryland, to three nearby emergency departments for possible spinal injury from 2006 through 2017. Patients suspected to have any spinal injury from beach activities were eligible. We excluded patients who could not verbalize their symptoms or with insufficient emergency department records. We compared components of each patient's HPI and PE with radiologic evidence of spinal injury. We calculated sensitivity, specificity, and negative and positive likelihood ratios (LRs).ResultsWe analyzed 278 patients with suspected spinal injury. Midline spinal tenderness was associated with increased likelihood of thoracic (LR+ 2.6) and lumbar spinal fractures (LR+ 3.5). HPI complaints of paralysis (LR+ 13.9) and sensory loss (LR+ 5.8) had strong associations with spinal cord injuries. Weakness found through PE was also associated with spinal cord injury (LR+ 5.3).ConclusionsWe identified several components of the clinical evaluation that had clinically significant association with spinal injuries from beach-related trauma. While prospective studies are needed to confirm our observations, clinicians may consider these high-risk features in patients with beach-related trauma and adjust testing and level of care appropriately.Copyright © 2020 Elsevier Inc. All rights reserved.

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