title: Are routine pelvic radiographs in major pediatric blunt trauma necessary?
abstract: BACKGROUND
  Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children.
  
  
  OBJECTIVE
  To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma.
  
  
  METHODS
  We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture.
  
  
  RESULTS
  Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS <14, positive urinalysis, abdominal pain/tenderness, femur fracture) and five high-risk mechanisms of injury (unrestrained motor vehicle collision [MVC], MVC with ejection, MVC rollover, auto vs. pedestrian, auto vs. bicycle).
  
  
  CONCLUSIONS
  Pelvic fractures in pediatric major blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients.
authors.affiliation: Emergency Medicine Department, Memorial Hermann Medical Center, Houston, TX, USA.
authors.forename: Jyothi
authors.initials: J
authors.lastname: Lagisetty
authors.forename: Thomas
authors.initials: T
authors.lastname: Slovis
authors.forename: Ronald
authors.initials: R
authors.lastname: Thomas
authors.forename: Stephen
authors.initials: S
authors.lastname: Knazik
authors.forename: Curt
authors.initials: C
authors.lastname: Stankovic
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008824:Michigan / Q000453:epidemiology; D010384:Pelvic Bones / Q000000981:diagnostic imaging*; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014600:Utilization Review; D014949:Wounds, Nonpenetrating / Q000453:epidemiology*