Routine pelvic x-ray studies in awake blunt trauma patients: a sensible policy?
To evaluate the usefulness of routine pelvic x-ray films in the resuscitation of blunt trauma victims, 1395 patients were prospectively evaluated over a 13-month period. Of these, 810 (58%) were awake with Glasgow Coma Scale scores greater than or equal to 13 and were enrolled into the study. A history, with directed questions regarding pelvic pain, a clinical examination of the pelvis, and an anterior-posterior pelvic x-ray film (APPX) were obtained for each patient. Thirty-nine patients (5%) had fractures identified on the x-ray films. Of these patients with radiographically identified fractures, 34 (87%) complained of pain and had positive results on clinical examination, two (5%) either complained of pain or had positive results on examination and three (8%) had neither complaint of pain nor positive examination results. Of the 771 patients without fractures 743 (96%) lacked pain complaints or positive examination results. The likelihood of fracture was greatest in patients with complaints of pain and positive examination results (65%) followed by patients with either complaint of pain or positive examination results (16%). Only three (0.4%) of the 743 patients having no complaints of pain and a negative clinical examination had fractures diagnosed roentgenographically. These were minor fractures that did not affect the clinical course. Total charges incurred to diagnose pelvic fractures in this low-yield patient group were $88,028. We conclude that the practice of obtaining a screening APPX is not necessary or cost-effective in the management of awake blunt trauma patients who do not complain of pain and who have normal pelvic physical examination results.
Salvino
C K
CK
Shock Trauma Institute, Loyola University Medical Center, Maywood, Illinois 60153.
Esposito
T J
TJ
Smith
D
D
Dries
D
D
Marshall
W
W
Flisak
M
M
Gamelli
R L
RL
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002985:Clinical Protocols / Q000592:standards*; D003362:Cost-Benefit Analysis; D005249:Fees and Charges; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015600:Glasgow Coma Scale; D006785:Hospitals, University; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D015601:Injury Severity Score; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D008487:Medical History Taking / Q000592:standards; D008875:Middle Aged; D016134:Organizational Policy; D010146:Pain / Q000453:epidemiology / Q000209:etiology*; D010384:Pelvic Bones / Q000293:injuries*; D010808:Physical Examination / Q000592:standards*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D014194:Traumatology / Q000458:organization & administration / Q000592:standards*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology