Using the Scratch Collapse Test to Detect Clinical or Subclinical Peroneal Palsy in the Hospitalized Patient in Order to Prevent Falls

Abstract

INTRODUCTION: The scratch collapse test (SCT) is an examination tool that can be used to localize and confirm a variety of nerve conditions. The implications and clinical utility in an inpatient population has not been extensively studied. The purpose of this study was to evaluate the use of SCT in a subset of hospitalized patients in order to identify the presence of subclinical PNP and thereby prevent falls.   METHODS: Hospitalized adult trauma patients at a single, academic, level one trauma center were recruited for the study. Patients found to have a positive scratch collapse test of the peroneal nerve were randomized to either receive a short period of inpatient physical therapy or serve as a no-intervention control.   RESULTS: Overall 29 patients (70.7%) recorded a positive SCT. Of those, 6 (20.7%) patients recorded a post-discharge fall. There were 14 patients with a positive SCT in the physical therapy intervention group with 2 patients (14.3%) who recorded a fall. There were 15 patients with a positive SCT in the no intervention group with 4 patients (26.7%) who recorded a fall.               CONCLUSION:  In this study, the SCT was used to identify subclinical peroneal nerve palsy, which could potentially lead to increased falls. While larger sample sizes are required for an adequately powered study, the SCT may serve as an inexpensive, useful tool in predicting which patients could be vulnerable to a post hospital fall due to subclinical peroneal nerve palsy.