Evidence map›Paper›PMID 38261076›Full record

Observational studyEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2024

Clinical validation of the "Straight-Leg-Evaluation-Trauma-Test" (SILENT) as a rapid assessment tool for injuries of the lower extremity in trauma bay patients.

Till Berk, Valentin Neuhaus, Catalina Nierlich, Zsolt J Balogh, Felix Karl-Ludwig Klingebiel, Yannik Kalbas, Hans-Christoph Pape, Sascha Halvachizadeh

Open access · hybridAbstract readObservational StudyValidation Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
1.4field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 2 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 2 countries.

Till BerkDepartment of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. Till.Berk@usz.ch.ORCID http://orcid.org/0000-0001-9582-1810
Valentin NeuhausDepartment of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Catalina NierlichFaculty of Medicine, University of Zurich, Raemistrasse 71, 8006, Zurich, Switzerland.
Zsolt J BaloghDepartment of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.
Felix Karl-Ludwig KlingebielDepartment of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Yannik KalbasDepartment of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Hans-Christoph PapeDepartment of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Sascha HalvachizadehDepartment of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
University of Zurich · CHJohn Hunter Hospital · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeClinical assessment of the major trauma patient follows international validated guidelines without standardized trauma-specific assessment of the lower extremities for injuries. This study aimed to validate a novel clinical test for lower extremity evaluation during trauma resuscitation phase.

methodsThis diagnostic, prognostic observational cohort study was performed on trauma patient treated at one level I trauma center between Mar 2022 and Mar 2023. The Straight-Leg-Evaluation-Trauma (SILENT) test follows three steps during the primary survey: inspection for obvious fractures (e.g., open fracture), active elevation of the leg, and cautious elevation of the lower extremity from the heel. SILENT was considered positive when obvious fracture was present and painful or pathological mobility was observed. The SILENT test was compared with standardized radiographs (CT scan or X-ray) as the reference test for fractures. Statistical analysis included sensitivity, specificity, and receiver operating characteristic testing.

results403 trauma bay patients were included, mean age 51.6 (SD 21.2) years with 83 fractures of the lower extremity and 27 pelvic/acetabular fractures. Overall sensitivity was 75% (95%CI 64 to 84%), and overall specificity was 99% (95%CI 97 to 100%). Highest sensitivity was for detection of tibia fractures (93%, 95%CI 77 to 99%). Sensitivity of SILENT was higher in the unconscious patient (96%, 95%CI 78 to 100%) with a near 100% specificity. AUC was highest for tibia fractures (0.96, 95%CI 0.92 to 1.0) followed by femur fractures (0.92, 95%CI 0.84 to 0.99).

conclusionThe SILENT test is a clinical applicable and feasible rule-out test for relevant injuries of the lower extremity. A negative SILENT test of the femur or the tibia might reduce the requirement of additional radiological imaging. Further large-scale prospective studies might be required to corroborate the beneficial effects of the SILENT test.

Indexed as

Trauma CentersAdultAgedFemaleFractures, BoneHumansInjury Severity ScoreLeg InjuriesLower ExtremityMaleMiddle AgedPhysical ExaminationSensitivity and SpecificityATLSPhysical examinationPrimary surveySILENT testTrauma bay

Identifiers

PMID38261076
PMCPMC11249611
OpenAlexW4391138905

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.