Critical evaluation of the 2-minute orthopedic screening examination
J. E. Gomez, G. L. Landry and D. T. Bernhardt
Department 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.
