Alcohol's role on the reliability of clinical examination to rule out pelvic fractures.
The objective of this study was to determine if clinical examination accurately ruled out pelvic fractures in intoxicated patients sustaining blunt trauma A prospective comparison of intoxicated (blood alcohol level [BAL] greater than 0.08 g/dL) to nonintoxicated (BAL less than 0.08 g/dL) patients sustaining blunt trauma was performed between February 2004 and March 2007. Clinical factors were compared and subset analysis performed in which patients with factors known to compromise the clinical examination were excluded. Two hundred ninety-six intoxicated patients were compared with 1071 nonintoxicated patients. Intoxicated patients were younger and more often male. Intoxicated patients had a higher heart rate (97.1 beats/min +/- 17.9 vs 91.4 beats/min +/- 18.7, P < 0.0001) and lower systolic blood pressure (136.2 mmHg +/- 21.2 vs 141.9 mmHg +/- 26.6, P = 0.0005) than nonintoxicated patients. Intoxicated patients had a lower incidence of pelvic fracture (6.1 vs 10.6%). In subset analysis, the majority of the intoxicated patients did not have exclusion factors on examination and could be evaluated (66.6%). There were eight pelvic fractures diagnosed in this group and no missed injuries on clinical examination (sensitivity 100%). Clinical examination was not compromised by intoxication. Routine pelvic x-rays are not needed in the alert, intoxicated patient sustaining blunt trauma.
Virginia Commonwealth University Medical Center, Richmond, Virginia, USA. tmduane@vcu.edu
Therèse M
TM
Duane
Tracey
T
Dechert
Luke G
LG
Wolfe
Holly
H
Brown
Michel B
MB
Aboutanos
Ajai K
AK
Malhotra
Rao R
RR
Ivatury
D000293:Adolescent; D000328:Adult; D000435:Alcoholic Intoxication / Q000150:complications*; D016022:Case-Control Studies; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D010808:Physical Examination; D011446:Prospective Studies; D012307:Risk Factors; D014949:Wounds, Nonpenetrating / Q000175:diagnosis*