Optimizing Pelvic X-Ray indication in blunt trauma patients using clinical criteria

Abstract

Objective: to identify a subgroup of blunt trauma patients with very low chance of sustaining pelvic fractures based on clinical criteria. Methods: retrospective analysis of the trauma registry data, collected in a period of 24 months. We selected adult blunt trauma patients who had a PXR on admission. The frequency of pelvic fractures was calculated for the following groups: Normal neurological examination at admission (NNE), hemodynamical stability (HS), normal pelvic examination at admission (NPE), less than 60 years old (ID<60) and absence of distracting injuries (ADI). Logistic regression analysis was carried out in order to create a probability model of negative PXR. Results: an abnormal PXR was identified in 101 (3.3%) out of the 3,055 patients who had undergone a PXR at admission. Out of these, 1,863 sustained a NNE, with 38 positive CXRs (2.0%) in this group. Considering only the 1,535 patients with NNE and HS, we found 28 positive PXRs (1.8%). Out of these, 1,506 have NPE, with 21 abnormal PXRs (1.4%). Of these, 1,202 were younger than 60 y, with 11 positive PXRs (0.9%). By adding all these criteria to the ADI, we found 2 abnormal PXRs in 502 (0.4%) cases. The probability model including all these variables had a 0,89 area under the ROC curve. Conclusions: by adding clinical criteria, it is possible to identify a group of trauma patients with very low chance of sustaining pelvic fractures. The necessity of PXR in these patients needs to be reassessed.

Beckentrauma

“…Hierbei können vorab gegebenenfalls grobe Fehlstellungen nachgewiesen werden. Diese Röntgenaufnahme wird in der aktuellen Literatur weiterhin kritisch diskutiert [2,31,32]. Die Bildgebung zur sicheren Darstellung einer Beckenverletzung ist heutzutage die CT mit Kontrastmittel [1,2,6].…”

“…Die Bildgebung zur sicheren Darstellung einer Beckenverletzung ist heutzutage die CT mit Kontrastmittel [1,2,6]. Aktuelle Empfehlungen sprechen sich nur noch für eine Röntgenbildgebung aus, wenn der Patient zu instabil für eine CT ist oder wenn der dringende Verdacht einer Hüftluxation besteht [31,32].…”