External signs of trauma: A poor predictor of injury in found down and ground level falls

Background: The significance of external signs (EST) and signs or symptoms of trauma (SS) after ground level falls or found down (GLF/FD) is unclear. We hypothesized that EST and SS were associated with injury. Methods: Patients with GLF/FD were retrospectively studied. SS was defined as having any EST, tenderness, or subjective complaint. Outcomes were any significant finding (SF) and Injury Severity Score (ISS) > 8. Diagnostic accuracy of EST and SS were assessed with positive and negative likelihood ratios (LR+, LR-). Results: Of 578 patients, 66% and 95% had EST and SS respectively. For EST, LR+ and LR-were 1.14 and 0.76 (SF), and 1.21 and 0.64 (ISS>8). For SS, LR+ and LR-were 1.07 and 0.19 (SF), and 1.03 and 0.49 (ISS>8). Conclusion: EST lacked sufficient diagnostic accuracy for SF and ISS>8. Lack of SS was reasonably accurate in ruling out SF but not ISS>8. Triage utilizing EST alone for GLF/FD is not useful.