Usefulness of Pelvic Radiographs in the Initial Trauma Evaluation with Concurrent CT: Is Additional Radiation Exposure Necessary?

Abstract

Trauma patients in a Level I Pediatric Trauma Center may undergo CT of the abdomen and pelvis with concurrent radiograph during initial evaluation in an attempt to diagnose injury. To determine if plain digital radiograph of the pelvis adds additional information in the initial trauma evaluation when CT of the abdomen and pelvis is also performed, trauma patients who presented to an urban Level I Pediatric Trauma Center between 1 January 2010 and 7 February 2017 in whom pelvic radiograph and CT of the abdomen and pelvis were performed within 24 hours of each other were analyzed. A total of 172 trauma patients had pelvic radiograph and CT exams performed within 24 hours of each other. There were 12 cases in which the radiograph missed pelvic fractures seen on CT and 2 cases in which the radiograph suspected a fracture that was not present on subsequent CT. Furthermore, fractures in the pelvis were missed on pelvic radiographs in 12 of 35 cases identified on CT. Sensitivity of pelvic radiograph in detecting fractures seen on CT was 65.7% with a 95% confidence interval of 47.79-80.87%. Results suggest that there is no added diagnostic information gained from a pelvic radiograph when concurrent CT is also obtained, a practice which exposes the pediatric trauma patient to unnecessary radiation.

Paediatric pelvic fractures – an updated literature review

“…Of further note (and not included in Fig. 4), patients who have acute indications for an abdominopelvic CT scan, such as those with a suspected intraabdominal injury should not have a pelvic x‐ray 79,82 . CT scans allow surgeons to diagnose injuries not visible on radiographs.…”

“…52,77 While CT can provide superior visualization and more detailed information of pelvic fractures than a standard pelvic radiograph, its routine use is contentious given high radiation exposures, cost and time compared with bedside pelvic radiographs. 34,[78][79][80][81] They should only be considered if the added information will affect a patient's management as most paediatric pelvic fractures are managed conservatively. 78 Of further note (and not included in Fig.…”

“…4 ), patients who have acute indications for an abdominopelvic CT scan, such as those with a suspected intraabdominal injury should not have a pelvic x‐ray. 79 , 82 CT scans allow surgeons to diagnose injuries not visible on radiographs. For instance, children with an SIJ disruption and an intact L5 transverse process can also have avulsion of the iliac crest – a finding that requires 3D imaging to detect.…”