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Critical evaluation of the 2-minute orthopedic screening examination
J E Gomez1, G L Landry, D T Bernhardt
1Department of Pediatrics, University of Texas Health Science Center at San Antonio.
Objective:
To determine the sensitivity and specificity of the 2-minute, 12-step, orthopedic screening examination.
Design:
Prospective, single-blind study.
Setting:
National Collegiate Athletic Association Division 1 athletics program.
Participants:
Two hundred fifty-nine male and female varsity athletes.
Interventions:
The athletes were screened by five primary care physicians who were "blind" to each patient's history. The athletes were then evaluated by a team of orthopedic surgeons who had knowledge of each patient's history. Significant injuries were injuries that would limit participation, predispose to injury, or need further evaluation or rehabilitation.
Main Results:
A total of 120 significant injuries were identified by compiling the results of the history and both physical examinations. Of the significant injuries, 91.6% were detected by history alone. Fourteen of the significant injuries were missed by the detailed orthopedic examination, but they were detected by the screening examination. The overall sensitivity of the screening examination compared with the results of all three methods was 50.8%, with a specificity of 97.5%, positive predictive value of 40.9%, and negative predictive value of 98.3%. Almost half of the false-positive screening findings were shoulder asymmetries.
Conclusions:
Even in mass screenings, the screening orthopedic examination should be used only in conjunction with an orthopedic history. Some modifications may improve the sensitivity of the screening examination.