This study assessed the efficacy of physical examination as a screening modality for the diagnosis of surgically significant @entity1317 in proximity penetrating extremity @entity130 (PPET). All cases of PPET were assessed and admitted per established protocol over a 30-month period from January 1, 1993, to June 30, 1995. No @entity1 were excluded if other body regions were also injured. Landmarks defining @entity130 were the deltopectoral groove to the wrist and for lower extremities from the inguinal ligament to the ankle. @entity1 admitted with PPET fell into one of three categories: 1) no hard signs of @entity1317 present-admitted for 24-hour observation; 2) presence of at least one hard sign of @entity1317 -taken immediately to the operating room; 3) positive sign of @entity1317 that requires angiography (i.e., diminished but appreciable pulse by physical examination or doppler, large nonexpanding @entity1410 , bilateral pulse deficit, no appreciable pulse with unreconstructable trajectory). Four hundred six @entity1 with 489 injured extremities secondary to PPET were admitted over a 30-month period. Sixty-two extremities suffered @entity1230 . Of the extremities injured, 83 per cent were secondary to gunshot wounds, 12 per cent were attributed to stabs/lacerations, and 5 per cent were due to shotgun @entity130 . Four hundred twenty-one extremities with PPET fell into Group 1. There were four missed @entity130 (specificity, 99%) in this group (one ulnar artery, one radial artery, one posterior tibial artery, and one anterior tibial artery). Two of these @entity130 were considered surgically significant. None of the @entity1 suffered limb or functional loss as a consequence of their missed @entity1317 . Thirty-nine extremities were entered into Group 2, with two @entity1 found to have no @entity1317 . Twenty-nine extremities were placed into Group 3 with 10 (35%) found to have surgically significant injury on angiogram. The overall sensitivity and specificity for physical examination was 92 per cent and 95 per cent, respectively, for surgically significant injury. Physical examination is a highly sensitive and specific screening modality for the identification of surgically significant @entity1317 in PPET. @entity1 who present with diminished, but appreciable, pulses by physical examination or doppler, large nonexpanding @entity1410 as the only sign, @entity51 and nonappreciable pulses with unreconstructable trajectory benefit from further investigation with angiography.

The utility of physical examination in proximity penetrating extremity XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity51 :: ('MESH:D009461', 'Disease') :: ['bilateral pulse deficits'] @entity1410 :: ('MESH:D006406', 'Disease') :: ['hematomas', 'hematoma'] @entity1230 :: ('MESH:D009104', 'Disease') :: ['multiple injuries'] @entity1317 :: ('MESH:D057772', 'Disease') :: ['arterial injury', 'vascular injury'] @entity130 :: ('MESH:D014947', 'Disease') :: ['injuries', 'upper extremity injuries', 'trauma']
@entity130 :: (MESH:D014947,Disease) :: ['trauma']
