Skip and save: utility of pelvic x-rays in the initial evaluation of blunt trauma patients

Soto, Jose Raul; Zhou, Cathy; Hu, David; Arazoza, Antonio; Dunn, Erica H.; Sladek, Phillip

doi:10.1016/j.amjsurg.2015.07.011

Cited by 16 publications

(10 citation statements)

References 3 publications

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“…This group proposes that there is no need to perform PXR in patients who will undergo CT scans. Other studies had similar findings [16][17][18]21 . This fact calls for well-established Objetivo: identificar, baseados em critérios clínicos, grupo de vítimas de trauma fechado com baixa probabilidade de apresentar fraturas na radiografia simples de pelve à admissão (RXP).…”

Section: Discussionunclassified

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

Moraes

Parreira

Antunes

et al. 2020

Rev. Col. Bras. Cir.

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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.

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Section: Discussionunclassified

“…Even when there is a fracture, in 22% of these cases the diagnosis is only possible through computed tomography 16 . Negative tests generate costs and increase the length of stay in the emergency services, which can worsen the patient's clinical prognosis and interfere with the patient's care flow.…”

Section: Introductionmentioning

confidence: 99%

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

Moraes

Parreira

Antunes

et al. 2020

Rev. Col. Bras. Cir.

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“…Plain radiography would detect the presence of free intraperitoneal gas, a hemothorax or pneumothorax or may be an exterior body. [38]…”

Section: Methodsmentioning

confidence: 99%

Management of multiple traumas in emergency medicine department: A review

Kashani

Saberinia

2019

J Family Med Prim Care

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One of the main causes of adults' disability during their working age is multiple trauma. The process of medical care of patients who are injured seriously is still a challenging job. The primary treatment of these patients in the emergency medicine departments is the most required choice after the wilderness first aid and also would be very required before definitive care in the hospital. The main aim of emergency medicine departments is quick recognition and treatment of injuries which pose severe threat to patients' life in appropriate order of priority. The procedure of primary evaluation in emergency medicine department with the help of medical routine examination and ultrasonography is based on the concept of focused assessment with sonography in trauma (FAST) for identifying spontaneous intraperitoneal hemorrhage. Emergency patients who suffer from massive hematothorax, serious lung and heart traumas, and penetrating traumas to the chest would undergo thoracotomy and patients who have few symptoms of perforated hollow viscous will undergo emergency laparotomy. Based on the trauma severity, emergency treatment could be the way to fast recovery of the structure of injured organ and its function. The subsequent goal, in the acute phase, will concentrate on preventing and stopping bleeding and secondary injuries like painful compartment syndrome or intra-abdominal infections (IAIs). However, the main aim of emergency medicine department in taking care of severely injured patients is the management of airway, protecting circulation and breathing, identification of neurologic problems, and whole body clinical examination with the help of healthcare providers.

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“…9 With comprehensive CT imaging suggested or performed for all transplant candidates, increasing medical expense becomes a critical area of consideration. 10 Despite growing attention on healthcare spending in the United States, health costs account for a larger percentage of the gross domestic product (GDP) than any other developed country. 11 In 2010, medical costs equaled 16% of the country's GDP, and increased to 18% in 2015.…”

Section: Introductionmentioning

confidence: 99%

“…Medical providers help evaluate and refine healthcare protocols to reduce costs and increase safety by eliminating procedures and interventions that add little patient care benefit. 10 In renal transplantation evaluations, expenses can be reduced by eliminating transplant evaluation CTs in situations where the imaging does not add significant value. Via a detailed medical history, patients at higher risk of an abnormal finding which would complicate or preclude transplantation can be readily identified to determine who benefits from the imaging.…”

Section: Introductionmentioning

confidence: 99%

The use of screening computed tomography prior to renal transplantation should be limited to high-risk patients with advanced age, coronary artery disease and diabetes mellitus

Patel

Alhana

et al. 2019

Int Surg J

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Background: Computed tomography (CT) scans’ predictive value is not well established for screening prior to renal transplantation. The purpose of this study is to measure the extent to which CT findings during transplant evaluation alter candidacy.Methods: Data for 639 renal transplant candidates who underwent CT screening were obtained. Of these, 454 patients had sufficient data and met criterium of having undergone screening CT within six months of official renal transplant evaluation. Transplant status before and after CT imaging was assessed.Results: Those who had screening CTs prior to renal transplantation who were older (p=0.01), had coronary artery disease (p=0.006), or had diabetes mellitus (p=0.042) had significant waitlist status changes. Candidates whose CT findings included vascular calcification or pulmonary nodules were more likely to be permanently excluded from the waitlist (p<0.05). Thirty-two, or 7.0%, had a permanent waitlist status change due to pathologic CT findings that precluded transplantation.Conclusions: Focusing on older patients with coronay artery disease, atherosclerosis, or diabetes would reduce the number of CTs obtained during workup. Candidates with systemic vascular calcification or pulmonary nodules found on subsequent imaging are at the greatest risk for permanent exclusion from renal transplantation.

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Skip and save: utility of pelvic x-rays in the initial evaluation of blunt trauma patients

Cited by 16 publications

References 3 publications

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

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

Management of multiple traumas in emergency medicine department: A review

The use of screening computed tomography prior to renal transplantation should be limited to high-risk patients with advanced age, coronary artery disease and diabetes mellitus

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