Pelvic radiography in ATLS algorithms: A diminishing role?

Abstract

Background: Pelvic x-ray is a routine part of the primary survey of polytraumatized patients according to Advanced Trauma Life Support (ATLS) guidelines. However, pelvic CT is the gold standard imaging technique in the diagnosis of pelvic fractures. This study was conducted to confirm the safety of a modified ATLS algorithm omitting pelvic x-ray in hemodynamically stable polytraumatized patients with clinically stable pelvis in favour of later pelvic examination by CT scan.

Conventional versus virtual radiographs of the injured pelvis and acetabulum

“…Fractures of the pelvis and acetabulum are uniquely suited to being evaluated with virtual instead of conventional plain radiographs as these injuries are being imaged exclusively with immediate CT scans with increasing frequency [8][9][10]. Once a CT scan has been performed, and provided interventions such as reduction, binder application, or traction are not indicated, virtual images serve as a viable, timely, and costeffective alternative that can decrease cost, patient discomfort, and radiation exposure.…”

“…Image quality can be compromised by suboptimal positioning, obesity, bowel gas, and bowel or bladder contrast [1][2][3][4]. Computed tomography (CT) scans are also performed for a more detailed assessment of the injury pattern [3,[5][6][7][8][9][10][11][12].…”

Accuracy of single-pass whole-body computed tomography for detection of injuries in patients with major blunt trauma

“…The trauma algorithm established at our institution does not allow for a comparison of accuracy indices between pan-scans and conventional diagnostic work-ups. [6][7][8]24 The imperfect reference standard used, which combined with clinical and radiologic tests, could have introduced partial verification bias, 25 and we may have underestimated the sensitivity of the pan-scan results because our definitions of true and false results may have been too conservative. Finally, we did not address the problem of nontraumatic incidental findings, which occur in up to one-third of all patients who undergo trauma scanning.…”

Evaluation of urogenital injuries in patients with trauma at the emergency department

“…Hilty ve arkadaşlarının [17] retrospektif olarak yaptı-ğı çalışmada çoklu travması olan 68 hasta değerlendi-rilmiş ve pelvis kırıklarının tam olarak saptanması için direkt grafi ile BT veya sadece BT çekilmesi karşılaş-tırılmıştır. Hemodinamik olarak stabil ve pelvisi stabil hastalarda direkt grafilerin duyarlılığı %67 olarak belirtilmiş ve BT planlanan hastalarda direkt grafi gerekmeyeceği belirtilmiştir.…”