title: Utility of plain film pelvic radiographs in blunt trauma patients in the emergency department.
abstract: The objective of this study was to evaluate the utility and sensitivity of routine pelvic radiographs (PXR) in the initial evaluation of blunt trauma patients. A retrospective review was performed. One hundred seventy-four patients with a pelvic fracture who had computed tomography (CT) and PXR were included (average age, 36.1; average Injury Severity Score, 16.3). Nine (5%) patients died. Five hundred twenty-one fractures were identified on CT. One hundred sixteen (22%) of these fractures were missed by PXR. Eighty-eight (51%) patients were underdiagnosed by PXR alone. The most common fractures missed by PXR were sacral and iliac fractures. Eight patients required angiograms, with four undergoing therapeutic pelvic embolization. Forty-seven (27%) patients were hypotensive or required a transfusion in the emergency department. These patients were more likely to require an angiogram (17% vs 0%, P < 0.0001) and were more likely to require embolization (9% vs 0%, P < 0.001). This study demonstrates that CT scan is highly sensitive in identifying and classifying pelvic fractures. PXR has a sensitivity of only 78 per cent for identification of pelvic fractures in the acute trauma patient. In hemodynamically stable patients who are going to undergo diagnostic CT scan, PXR is of little value. The greatest use of PXR may be as a screening tool in hemodynamically unstable patients and/or those that require transfusion to allow for early notification of the interventional radiology team.
authors.affiliation: University of California Irvine Medical Center, Orange 92868, USA.
authors.forename: Amal Kamil
authors.initials: AK
authors.lastname: Obaid
authors.forename: Andrew
authors.initials: A
authors.lastname: Barleben
authors.forename: Diana
authors.initials: D
authors.lastname: Porral
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lush
authors.forename: Marianne
authors.initials: M
authors.lastname: Cinat
mesh_terms: D000077:Acetabulum / Q000293:injuries; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004621:Embolization, Therapeutic; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D007022:Hypotension / Q000628:therapy; D007085:Ilium / Q000293:injuries; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D012189:Retrospective Studies; D012447:Sacrum / Q000293:injuries; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*