The Value of Clinical Examination in Diagnosing Pelvic Fractures in Blunt Trauma Patients: a Brief Review

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2011 Sep 28

PMID 21949543

Citations 2

Authors

T A W den Boer

M Geurts

L T van Hulsteijn

A Mubarak

J Slingerland

B Zwart

G J M G Van der Heijden

T J Blokhuis

Affiliations

Soon will be listed here.

Abstract

Purpose Of The Study: To evaluate the value of a pelvic X-ray compared to clinical examination in diagnosing pelvic ring fractures, using computed tomography (CT) as the gold standard, in alert [Glasgow Coma Scale (GCS) ≥ 13] adult blunt trauma patients in the emergency room.

Methods: A systematic literature search was performed in PubMed and Embase. The results were screened on their titles and abstracts using in- and exclusion criteria. Subsequently, the selected articles were critically appraised for their relevance and validity.

Results: Two studies investigating the diagnostic value of clinical examination and pelvic X-ray compared to CT were identified. Both studies demonstrate higher negative predictive values for clinical examination [0.99 (95% confidence interval [CI] 0.98-1.0) and 1.0 (95% CI 0.99-1.0)] compared to the negative predictive values of pelvic X-ray [0.98 (95% CI 0.93-0.99) and 0.99 (95% CI 0.99-1.0)]. The positive predictive values for clinical examination were low [0.18 (95% CI 0.16-0.23) and 0.35 (95% CI 0.30-0.42)] compared to pelvic X-ray [0.97 (95% CI 0.96-0.98) and 0.97 (95% CI 0.90-0.99)].

Conclusions: In alert blunt trauma patients, pelvic X-ray only has additional diagnostic value for the detection of pelvic ring fractures if the clinical examination is positive. Pelvic X-ray should not be performed if the clinical examination is negative. In this manner, the expenditure of time, costs, and radiation are optimized.

Citing Articles

Imaging in polytrauma - Principles and current concepts.

Thippeswamy P, Rajasekaran R J Clin Orthop Trauma. 2021; 16:106-113.

PMID: 33717944 PMC: 7920130. DOI: 10.1016/j.jcot.2020.12.006.

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

Okada Y, Nishioka N, Ohtsuru S, Tsujimoto Y World J Emerg Surg. 2020; 15(1):56.

PMID: 33008428 PMC: 7531119. DOI: 10.1186/s13017-020-00334-z.

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