title: Implementation of a cost-saving algorithm for pelvic radiographs in blunt trauma patients.
abstract: BACKGROUND
  In a previous retrospective study, we demonstrated that pelvic radiographs (PXRs) in the evaluation of blunt trauma patients undergoing abdominal computed tomographic (CT) scanning have limited utility in the absence of hemodynamic instability and significant physical findings. The purpose of this study was to prospectively validate an algorithm defining indications for PXR in blunt trauma patients in the emergency department.
  
  
  METHODS
  We performed a prospective observational study of consecutive blunt trauma patients over 6 months at a single Level 1 trauma center. The trauma faculty agreed to implement an algorithm of obtaining PXRs in patients undergoing abdominal CT scanning only if a specific set of criteria were met: systolic blood pressure <90 mm Hg, hemoglobin <8 mg/dL, a drop in Hgb of more than 3 mg/dL while in the trauma bay, or significant physical examination findings. The algorithm could be overridden at the discretion of the attending physician.
  
  
  RESULTS
  Nine hundred ninety-five consecutive blunt trauma patients whose evaluation was to include an abdominal CT scan were included in the study. Only 54 patients (6%) received a PXR. Fifty-six indications for PXR were provided: 35 (63%) severe pelvic pain, 14 (25%) proximal fractures, 3 (5%) hip dislocations, and only 4 (7%) had unexplained hypotension. No adverse events or delays in care occurred such as hypotension in the CT scanner or a delay in contacting interventional radiology, blood transfusion, or application of a pelvic binder. The algorithm selected PXR for patients who were more likely to have a pelvic fracture (33% vs. 4.5%, p < 0.001), hip dislocation (7.4% vs. 0.1%, p < 0.001), femur fracture (22.2% vs. 2.7%, p < 0.001), and to require blood transfusion (11.1% vs. 1.9%, p < 0.001). Implementation of this algorithm resulted in a decrease in charges of >$226,000 in 6 months.
  
  
  CONCLUSIONS
  When objective evaluation of the abdomen is to be obtained via CT scanning, PXR in the emergency department is obsolete in the absence of hemodynamic instability and significant physical examination findings. Implementation of a selective algorithm in this patient population can result in significant cost savings without adverse patient outcomes.
authors: Division of Trauma, Burns, Critical Care, and Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, California 92868, USA.
authors: Andrew
authors: A
authors: Barleben
authors: Fariba
authors: F
authors: Jafari
authors: John
authors: J
authors: Rose
authors: Matthew
authors: M
authors: Dolich
authors: Darren
authors: D
authors: Malinoski
authors: Michael
authors: M
authors: Lekawa
authors: David
authors: D
authors: Hoyt
authors: Marianne
authors: M
authors: Cinat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002985:Clinical Protocols; D015331:Cohort Studies; D017046:Cost Savings; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010384:Pelvic Bones / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging*; D055815:Young Adult