Role of routine pelvic radiography in initial evaluation of stable, high-energy, blunt trauma patients

Abstract

Pelvic radiography could be eliminated from the primary survey protocol of the patients with high-energy blunt trauma who are haemodynamically stable and have negative pelvic physical examination.

Pelvic trauma: WSES classification and guidelines

“…As clearly demonstrated by the literature blood products, coagulation factors and drugs administration has to be guided by a tailored approach through advanced evaluation of the patient’s coaugulative asset [16–22]. Some authors consider a normal hemodynamic status when the patient does not require fluids or blood to maintain blood pressure, without signs of hypoperfusion; hemodynamic stability as a counterpart is the condition in which the patient achieve a constant or an amelioration of blood pressure after fluids with a blood pressure >90 mmHg and heart rate <100 bpm [23]; hemodynamic instability is the condition in which the patient has an admission systolic blood pressure <90 mmHg, or > 90 mmHg but requiring bolus infusions/transfusions and/or vasopressor drugs and/or admission base deficit (BD) >6 mmol/l and/or shock index > 1 [24, 25] and/or transfusion requirement of at least 4–6 Units of packed red blood cells within the first 24 hours [5, 16, 26]. The Advanced Trauma Life Support (ATLS) definition considers as “unstable” the patient with: blood pressure < 90 mmHg and heart rate > 120 bpm, with evidence of skin vasoconstriction (cool, clammy, decreased capillary refill), altered level of consciousness and/or shortness of breath [26].…”

The Predictive Value of Repeated Abdominal Ultrasonography in Patients with Multiple Trauma and Decreased Level of Consciousness: The Experience of a Resource-Limited Centre

“…Nevertheless, CT imaging has some disadvantages. Among these are its cost, the risk of contrast-induced nephropathy, patients' exposure to radiation, probable anaphylactic reaction to intravenous contrast, and its time-consuming nature (the need to patient transport) [7,8,10]. Another concern is that CT scan study of the children with trauma may increase the risk of cancer in the future [11,12].…”

“…The cost of maintenance and wear and tear of the equipment is the other problem. From another point of view, lack of suitable access to this facility in some regions of the world, mainly in developing countries like Iran, is greatly evident [10,13]. Moreover, in disaster or mass casualty conditions, such as hurricanes and tornadoes, major earthquakes, floods, etc., the need to alternative methods to the CT scan shows itself.…”

Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre

“…In this respect, previously, three studies were conducted by Shiraz Trauma Research Center to establish some criteria for the selection of those blunt trauma patients who need X-rays at their initial evaluation 1 12 13. The current study was undertaken in continuation of those prior studies to prospectively document the outcomes of applying said selection criteria in clinical practice.…”

“…Among these are three studies conducted by the Shiraz Trauma Research Center, Shiraz, Iran 1 12 13. Based on evidence from the Advanced Trauma Life Support (ATLS) protocol, the National Emergency X-Radiography Utilization Study criteria and other preceding surveys, these studies established concise criteria for the selective imaging of the neck, chest and pelvis in blunt trauma patients and examined its safety 1 6 8 12 13. However, the implications of applying such criteria in clinical practice have not been well studied.…”