Routine pelvic X-rays in asymptomatic hemodynamically stable blunt trauma patients: A meta-analysis

Abstract

In awake, hemodynamically and respiratory stable blunt trauma patients, PE could identify those patients who could safely forgo pelvic X-ray. Selective ordering of pelvic X-ray may lead to a decrease in patient work-up time, lower radiation exposure, and reduce costs. A decision making flow chart is proposed..

Diagnostic Accuracy of Physical Examination for Detecting Pelvic Fractures Among Blunt Trauma Patients: A Systematic Review and Meta-Analysis

“…Previous reviews concluded that physical examination was useful for excluding pelvic fracture in alert trauma patients. [7,9] By contrast, the present review revealed that the clinical utility of physical examination varied between settings and level of consciousness. In tertiary care settings such as trauma centers, the clinical bene t of physical examination appeared lower than that of imaging tests for all trauma patients.…”

“…First, this systematic review was based on a comprehensive literature search. By contrast, two previous systematic reviews of pelvic fracture physical examination [7,9] failed to incorporate several important studies owing to inadequate search. [10,11,39,43,45,50] Second, the current review included study quality assessment and a methodologically rigorous meta-analysis.…”

“…[16][17][18] By contrast, two previous systematic reviews had critical limitations to their methodology. [7,9] One review [7] lacked quality assessment, and both previous reviews followed an unsuitable methodology of meta-analysis that did not include a hierarchical model. [7,9] Third, in subgroup analysis, we examined between-study heterogeneity in the diagnostic accuracy of patients with and without impaired consciousness; no previous systematic review investigated the sources of heterogeneity.…”

“…[7,9] One review [7] lacked quality assessment, and both previous reviews followed an unsuitable methodology of meta-analysis that did not include a hierarchical model. [7,9] Third, in subgroup analysis, we examined between-study heterogeneity in the diagnostic accuracy of patients with and without impaired consciousness; no previous systematic review investigated the sources of heterogeneity. Fourth, we assessed clinical utility by using decision curve analysis; no previous review has assessed the clinical utility of physical examination for pelvic fracture.…”

Diagnostic accuracy of physical examination for detecting pelvic fractures among blunt trauma patients: a systematic review and meta-analysis

“…Pelvic fracture diagnosis entails physical examination of the pelvis, which is generally performed in prehospital settings or at an emergency department [4][5][6]. It includes the inspection of deformities and the palpation of the pelvis to assess stability; it can be useful as a triage tool or to reduce the frequency of the imaging test [7][8][9]. Nevertheless, some studies [10][11][12] have challenged the reliability of physical examination, in particular, among patients with impaired consciousness.…”