title: Pelvic trauma imaging: a blinded comparison of computed tomography and roentgenograms.
abstract: To determine the sensitivity for detecting pelvic pathology and instability, roentgenograms and computed tomographic (CT) scans from 59 patients with pelvic injuries that had been admitted to a Level I trauma center were randomly reviewed by a orthopedic surgeon blinded to the study. Normal control roentgenograms and CT scans were included to decrease observer bias. The anteroposterior (AP) roentgenogram detected 66% of all pelvic injuries, 78% of those involving the anterior ring, and 53% of those involving the posterior pelvic ring. The trauma CT scan, 10-mm axial images of the abdomen and pelvis, detected 86% of all pelvic injuries, and 78% of anterior ring and 93% of posterior ring injuries. The sensitivity for detecting pelvic instability from one plain film AP pelvis roentgenogram taken in a trauma room setting was 74%. Inlet and outlet views were 75% sensitive. Trauma CT scans were 93% sensitive and high-definition pelvic CT scans (5-mm pelvic cuts) yielded 100% sensitivity. The mechanism of injury could be ascertained with 73% sensitivity by plain films and with 79% sensitivity by inlet and outlet views; trauma CT scans were 96% and high-definition pelvic CT scans were 100% sensitive. When combined, the AP pelvis roentgenograms and trauma CT scans identified 96% of the injured structures and were 100% sensitive in determining injury force patterns and instability. The data suggested that a good quality AP pelvis roentgenogram in conjunction with a complete trauma CT scan of the abdomen/pelvis should identify both the injury mechanism and pelvic instability with a high degree of sensitivity.
authors.affiliation: Department of Orthopaedic Surgery, University of South Carolina School of Medicine, Columbia, USA.
authors.forename: E E
authors.initials: EE
authors.lastname: Berg
authors.forename: C
authors.initials: C
authors.lastname: Chebuhar
authors.forename: R M
authors.initials: RM
authors.lastname: Bell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging* / Q000293:injuries*; D011897:Random Allocation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers