Necessity of routine pelvic radiograph in the pediatric blunt trauma patient.
BACKGROUND
Pelvic radiographs are obtained frequently in pediatric blunt trauma. The authors hypothesize that there are clinical indicators that can predict pelvic fracture on a pelvic radiograph in the pediatric blunt trauma patient with a Glasgow Coma Scale score of 14 or 15.


METHODS
A retrospective case-control study of 33 patients with pelvic fractures and 63 patients without pelvic fractures was performed.


RESULTS
8 evaluated clinical indicators showed that pelvic contusions and abrasions (P = .026), hip/pelvic pain (P<.001), abdominal pain and distension (P = .006), back pain (P = .080), hip held in rotation at presentation (P = .026), and femur deformity/pain (P = .002) were independently predictive of pelvic fracture. In combination, absence of hip/pelvic pain, pelvic contusions and abrasions, abdominal pain/distension, and femur deformity/pain showed a negative predictive value of 87%.


CONCLUSIONS
Clinical indicators may be useful in determining the need for pelvic radiographs in awake and alert pediatric blunt trauma patients.
Johns Hopkins Department of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. dana.ramirez@chkd.org
Dana W E
DW
Ramirez
Jennifer J
JJ
Schuette
Vinita
V
Knight
Elizabeth
E
Johnson
Justin
J
Denise
Allen R
AR
Walker
D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D015600:Glasgow Coma Scale; D006305:Health Status Indicators; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010384:Pelvic Bones / Q000000981:diagnostic imaging* / Q000293:injuries*; D011237:Predictive Value of Tests; D012372:ROC Curve; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*