title: The value of clinical examination in diagnosing pelvic fractures in blunt trauma patients: a brief review.
abstract: OBJECTIVE
  To evaluate the value of a pelvic X-ray compared to clinical examination in diagnosing pelvic ring fractures, using computed tomography (CT) as the gold standard, in alert [Glasgow Coma Scale (GCS) ≥ 13] adult blunt trauma patients in the emergency room.
  
  
  METHODS
  A systematic literature search was performed in PubMed and Embase. The results were screened on their titles and abstracts using in- and exclusion criteria. Subsequently, the selected articles were critically appraised for their relevance and validity.
  
  
  RESULTS
  Two studies investigating the diagnostic value of clinical examination and pelvic X-ray compared to CT were identified. Both studies demonstrate higher negative predictive values for clinical examination [0.99 (95% confidence interval [CI] 0.98-1.0) and 1.0 (95% CI 0.99-1.0)] compared to the negative predictive values of pelvic X-ray [0.98 (95% CI 0.93-0.99) and 0.99 (95% CI 0.99-1.0)]. The positive predictive values for clinical examination were low [0.18 (95% CI 0.16-0.23) and 0.35 (95% CI 0.30-0.42)] compared to pelvic X-ray [0.97 (95% CI 0.96-0.98) and 0.97 (95% CI 0.90-0.99)].
  
  
  CONCLUSIONS
  In alert blunt trauma patients, pelvic X-ray only has additional diagnostic value for the detection of pelvic ring fractures if the clinical examination is positive. Pelvic X-ray should not be performed if the clinical examination is negative. In this manner, the expenditure of time, costs, and radiation are optimized.
authors.forename: T A W
authors.initials: TA
authors.lastname: den Boer
authors.forename: M
authors.initials: M
authors.lastname: Geurts
authors.forename: L T
authors.initials: LT
authors.lastname: van Hulsteijn
authors.forename: A
authors.initials: A
authors.lastname: Mubarak
authors.forename: J
authors.initials: J
authors.lastname: Slingerland
authors.forename: B
authors.initials: B
authors.lastname: Zwart
authors.forename: G J M G
authors.initials: GJ
authors.lastname: van der Heijden
authors.forename: T J
authors.initials: TJ
authors.lastname: Blokhuis