Validation of a decision instrument to limit pelvic radiography in blunt trauma

Gross, Eric; Niedens, B. A.

doi:10.1016/j.jemermed.2004.10.013

Cited by 15 publications

(5 citation statements)

References 9 publications

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“…Yugueros et al 4 performed a prospective analysis and found that a negative physical examination had a negative predictive value of 99 per cent in patients that are adults with a Glasgow Coma Score of greater than 10, are hemodynamically stable, have no evidence of blood loss, and have no spinal cord injury. Similarly, Gross et al 5 established a decision instrument to determine which patients should undergo PXR in the ED. The decision tool included five criteria: altered level of consciousness, complaint of pelvic pain, pelvic tenderness, distracting injury, and the presence of clinical intoxication.…”

Section: Discussionmentioning

confidence: 99%

Utility of Plain Film Pelvic Radiographs in Blunt Trauma Patients in the Emergency Department

Obaid

Barleben

Porral

et al. 2006

The American Surgeon™

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The objective of this study was to evaluate the utility and sensitivity of routine pelvic radiographs (PXR) in the initial evaluation of blunt trauma patients. A retrospective review was performed. One hundred seventy-four patients with a pelvic fracture who had computed tomography (CT) and PXR were included (average age, 36.1; average Injury Severity Score, 16.3). Nine (5%) patients died. Five hundred twenty-one fractures were identified on CT. One hundred sixteen (22%) of these fractures were missed by PXR. Eighty-eight (51%) patients were underdiagnosed by PXR alone. The most common fractures missed by PXR were sacral and iliac fractures. Eight patients required angiograms, with four undergoing therapeutic pelvic embolization. Forty-seven (27%) patients were hypotensive or required a transfusion in the emergency department. These patients were more likely to require an angiogram (17% vs 0%, P < 0.0001) and were more likely to require embolization (9% vs 0%, P < 0.001). This study demonstrates that CT scan is highly sensitive in identifying and classifying pelvic fractures. PXR has a sensitivity of only 78 per cent for identification of pelvic fractures in the acute trauma patient. In hemodynamically stable patients who are going to undergo diagnostic CT scan, PXR is of little value. The greatest use of PXR may be as a screening tool in hemodynamically unstable patients and/or those that require transfusion to allow for early notification of the interventional radiology team.

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Section: Discussionmentioning

confidence: 99%

Utility of Plain Film Pelvic Radiographs in Blunt Trauma Patients in the Emergency Department

Obaid

Barleben

Porral

et al. 2006

The American Surgeon™

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“…PXR is superior to the clinical examination in the hemodynamically unstable patient, but less sensitive than CT for identifying fractures. It detects 68%-78% of fractures visible on CT and less than half of posterior fractures (38)(39)(40).PXR is however considered useful in patients who cannot proceed to CT for clinical priorities and in patients with pelvic pain, distracting injuries, altered level of consciousness and presence of clinical intoxication (41).…”

Section: Pelvic X-raymentioning

confidence: 99%

Efficacy of plain radiography and computer tomography in localizing the site of pelvic arterial bleeding in trauma patients

et al. 2010

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“…We plan to develop a specific decision instrument using these specific criteria for targeted pelvic radiography. A similar decision instrument has been successfully shown to have high sensitivity and specificity for adults [2]. Successful implementation of such a decision instrument would help limit radiation exposure, decrease wasted time and resources of the radiology department and minimize unnecessary patient expenditures.…”

Section: Resultsmentioning

confidence: 99%

“…Pelvic fractures are uncommon in children, but are associated with significant morbidity while the work-up and treatment for these injuries is costly [1,2]. The American College of Surgeons Committee on Trauma (ACS COT), recommends the use of pelvic radiography for all patients who have sustained a multisystem blunt traumatic injury [3,4].…”

Section: Introductionmentioning

confidence: 99%

Prehospital predictors of risk for pelvic fractures in pediatric trauma patients

et al. 2008

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Pelvic fractures are uncommon in children, but can occur as a result of high-energy impact injuries to the lower torso in association with blunt trauma. Pelvic fractures can be associated with significant morbidity while the work-up and treatment for these injuries is costly. The aim was to identify risk factors that help determine which pediatric trauma patients are at highest risk of sustaining a pelvic fracture to aid in the development of criteria for the targeted use of pelvic radiographic imaging. A retrospective analysis was conducted using the only pediatric trauma registry in the state of Maryland, located at The Johns Hopkins Children's Center. All blunt trauma patients who were younger than 15 years of age from 1990 to 2005 were included in the analysis (n = 13,360) with a final diagnosis of pelvic fracture as the primary outcome of interest. Comparisons were made using Pearson's chi-square for categorical and the Mann-Whitney rank sum test for non-normally distributed variables. Pelvic fractures following blunt trauma in children are associated with age, race, place and mechanism of injury. Compared to children 4 years and younger, pelvic fractures were more likely to occur in children aged 5-9 years (OR = 3; P = 0.000), as well as 10-14 years (OR = 5; P = 0.000). Compared to blunt trauma injuries from falls, children who were struck by vehicles or who were occupants in motor vehicle crashes (MVC) were six times (P = 0.000) and twice (P = 0.02) as likely to sustain a pelvic fracture, respectively. Four factors were demonstrated by this study to be significantly associated with pediatric pelvic fractures: being Caucasian, age between 5 and 14 years, being struck as a pedestrian or a motor vehicle crash occupant. Identification of these factors may aid clinicians in selecting patients who are at highest risk for pelvic fracture and may benefit most from pelvic radiography.

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Validation of a decision instrument to limit pelvic radiography in blunt trauma

Cited by 15 publications

References 9 publications

Utility of Plain Film Pelvic Radiographs in Blunt Trauma Patients in the Emergency Department

Utility of Plain Film Pelvic Radiographs in Blunt Trauma Patients in the Emergency Department

Efficacy of plain radiography and computer tomography in localizing the site of pelvic arterial bleeding in trauma patients

Prehospital predictors of risk for pelvic fractures in pediatric trauma patients

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