The reliability of clinical examination in detecting pelvic fractures in blunt trauma patients: a meta-analysis.
BACKGROUND
Several studies have recently questioned whether routine radiographic screening for pelvic fractures is necessary in the initial evaluation of blunt trauma patients. Therefore, we assessed how sensitive and specific the clinical examination is in detecting fractures of the pelvis.


METHODS
We extensively searched various medical databases for studies that reported on the accuracy of pelvic examination in severely injured adults or children. Individual study results were summarized in a receiver operating characteristics (ROC) curve and pooled in a meta-analysis.


RESULTS
Twelve studies with a total of 5454 patients met our inclusion criteria and provided data in sufficient detail. Pooled sensitivity and specificity were 0.90 (95% confidence interval: 0.85-0.93) and 0.90 (0.84-0.94), respectively. Results were better in those studies which excluded neurologically impaired patients [e.g., Glasgow Coma Scale (GCS) <13]. Among the 49 false negative cases whose fractures went undetected on clinical examination, the majority of patients had either altered consciousness or minor pelvic fracture only. Only 3 clinically relevant pelvic fractures were missed among 441 patients with fracture within a total population of 5235 patients.


CONCLUSIONS
In stable and alert trauma patients, a thorough clinical examination will detect pelvic fractures with nearly 100% sensitivity, thus rendering initial radiography unnecessary in this group of patients.
Sauerland
Stefan
S
2nd Department of Surgery, University of Cologne, Ostmerheimer Str. 200, 51109, Cologne, Germany. S.Sauerland@uni-koeln.de
Bouillon
Bertil
B
Rixen
Dieter
D
Raum
Marcus R
MR
Koy
Timmo
T
Neugebauer
Edmund A M
EA
D005188:False Negative Reactions; D005189:False Positive Reactions; D050723:Fractures, Bone / Q000175:diagnosis*; D006801:Humans; D010384:Pelvic Bones / Q000293:injuries*; D010808:Physical Examination; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014949:Wounds, Nonpenetrating / Q000150:complications*