Are Routine Pelvic Radiographs in Major Pediatric Blunt Trauma Necessary?

Overview

Journal Pediatr Radiol

Specialty Pediatrics

Date 2012 Jan 17

PMID 22246414

Citations 5

Authors

Jyothi Lagisetty

Thomas Slovis

Ronald Thomas

Stephen Knazik

Curt Stankovic

Affiliations

Soon will be listed here.

Abstract

Background: Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children.

Objective: To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma.

Materials And Methods: We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture.

Results: Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS <14, positive urinalysis, abdominal pain/tenderness, femur fracture) and five high-risk mechanisms of injury (unrestrained motor vehicle collision [MVC], MVC with ejection, MVC rollover, auto vs. pedestrian, auto vs. bicycle).

Conclusion: Pelvic fractures in pediatric major blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients.

Citing Articles

Developing a decision instrument to guide abdominal-pelvic imaging of blunt trauma patients: Methodology and protocol of the NEXUS abdominal-pelvic imaging study.

Raja A, Rodriguez R, Gupta M, Isaacs E, Kornblith L, Prabhakar A PLoS One. 2022; 17(7):e0271070.

PMID: 35877687 PMC: 9312398. DOI: 10.1371/journal.pone.0271070.

Paediatric pelvic fractures - an updated literature review.

Nguyen A, Drynan D, Holland A ANZ J Surg. 2022; 92(12):3182-3194.

PMID: 35781759 PMC: 10084350. DOI: 10.1111/ans.17890.

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.

Demographic Characteristics of Paediatric Pelvic Fractures: 10-Years' Experience of Single Paediatric Orthopaedics Clinic.

Turgut A, Kalenderer O, Gunaydin B, Korkmaz M, Ilyas G, Ipci F Eurasian J Med. 2015; 47(2):130-4.

PMID: 26180498 PMC: 4494548. DOI: 10.5152/eurasianjmed.2015.134.

[The injured child--diagnostic work-up in the emergency room].

Schoneberg C, Schweiger B, Metzelder M, Muller D, Tschiedel E, Lendemans S Unfallchirurg. 2014; 117(9):829-41.

PMID: 25182238 DOI: 10.1007/s00113-014-2656-6.

References

Arias E, MacDorman M, Strobino D, Guyer B . Annual summary of vital statistics--2002. Pediatrics. 2003; 112(6 Pt 1):1215-30. DOI: 10.1542/peds.112.6.1215. View

WILLIAMS M, Lockey A, Culshaw M . Improved trauma management with advanced trauma life support (ATLS) training. J Accid Emerg Med. 1997; 14(2):81-3. PMC: 1342874. DOI: 10.1136/emj.14.2.81. View

Rothenberger D, Fischer R, Strate R, Velasco R, PERRY Jr J . The mortality associated with pelvic fractures. Surgery. 1978; 84(3):356-61. View

Gonzalez R, Fried P, Bukhalo M . The utility of clinical examination in screening for pelvic fractures in blunt trauma. J Am Coll Surg. 2002; 194(2):121-5. DOI: 10.1016/s1072-7515(01)01153-x. View

Guillamondegui O, Mahboubi S, Stafford P, Nance M . The utility of the pelvic radiograph in the assessment of pediatric pelvic fractures. J Trauma. 2003; 55(2):236-9; discussion 239-40. DOI: 10.1097/01.TA.0000079250.80811.D1. View

Almen A, Mattsson S . The radiation dose to children from X-ray examinations of the pelvis and the urinary tract. Br J Radiol. 1995; 68(810):604-13. DOI: 10.1259/0007-1285-68-810-604. View

Silber J, Flynn J, Koffler K, Dormans J, Drummond D . Analysis of the cause, classification, and associated injuries of 166 consecutive pediatric pelvic fractures. J Pediatr Orthop. 2001; 21(4):446-50. View

Junkins E, Furnival R, Bolte R . The clinical presentation of pediatric pelvic fractures. Pediatr Emerg Care. 2001; 17(1):15-8. DOI: 10.1097/00006565-200102000-00004. View

Demetriades D, Karaiskakis M, Velmahos G, Alo K, Murray J, Chan L . Pelvic fractures in pediatric and adult trauma patients: are they different injuries?. J Trauma. 2003; 54(6):1146-51; discussion 1151. DOI: 10.1097/01.TA.0000044352.00377.8F. View

10.

Bond S, Gotschall C, Eichelberger M . Predictors of abdominal injury in children with pelvic fracture. J Trauma. 1991; 31(8):1169-73. View

11.

Koury H, Peschiera J, Welling R . Selective use of pelvic roentgenograms in blunt trauma patients. J Trauma. 1993; 34(2):236-7. DOI: 10.1097/00005373-199302000-00010. View

12.

Salvino C, Esposito T, Smith D, Dries D, Marshall W, Flisak M . Routine pelvic x-ray studies in awake blunt trauma patients: a sensible policy?. J Trauma. 1992; 33(3):413-6. DOI: 10.1097/00005373-199209000-00013. View

13.

Danseco E, Miller T, Spicer R . Incidence and costs of 1987-1994 childhood injuries: demographic breakdowns. Pediatrics. 2000; 105(2):E27. DOI: 10.1542/peds.105.2.e27. View

14.

Agnew S . Hemodynamically unstable pelvic fractures. Orthop Clin North Am. 1994; 25(4):715-21. View

15.

Obaid A, Barleben A, Porral D, Lush S, Cinat M . Utility of plain film pelvic radiographs in blunt trauma patients in the emergency department. Am Surg. 2006; 72(10):951-4. DOI: 10.1177/000313480607201025. View

16.

Junkins Jr E, Nelson D, Carroll K, Hansen K, Furnival R . A prospective evaluation of the clinical presentation of pediatric pelvic fractures. J Trauma. 2001; 51(1):64-8. DOI: 10.1097/00005373-200107000-00010. View

17.

Soundappan S, Smith N, Lam L, Holland A, McCaskill M, Cass D . A trauma series in the injured child: do we really need it?. Pediatr Emerg Care. 2006; 22(10):710-6. DOI: 10.1097/01.pec.0000236833.62065.85. View

18.

Rees M, Aickin R, Kolbe A, Teele R . The screening pelvic radiograph in pediatric trauma. Pediatr Radiol. 2001; 31(7):497-500. DOI: 10.1007/s002470100473. View

19.

Ismail N, Bellemare J, Mollitt D, DiScala C, Koeppel B, Tepas 3rd J . Death from pelvic fracture: children are different. J Pediatr Surg. 1996; 31(1):82-5. DOI: 10.1016/s0022-3468(96)90324-3. View

20.

PATTERSON F, MORTON K . The cause of death in fractures of the pelvis: with a note on treatment by ligation of the hypogastric (internal iliac) artery. J Trauma. 1973; 13(10):849-56. View