title: The diminishing role of pelvic x-rays in the management of patients with major torso injuries.
abstract: BACKGROUND
  A pelvic x-ray (PXR) can be used as an effective screening tool to evaluate pelvic fractures and stability. However, associated intra-abdominal/retroperitoneal organ injuries and hemorrhage should also be considered and evaluated in patients with major torso injuries. An abdominal/pelvic computed tomographic (CT) scan may provide higher resolution and more information than a PXR. The role of conventional PXRs was delineated in the current study in the context of the development of the CT scan.
  
  
  METHODS
  We retrospectively reviewed patients with major torso injuries in our institution. The characteristics of the patients who received different diagnostic modalities (PXR only, CT scan only, or both) were investigated and compared. The characteristics of patients who underwent transcatheter arterial embolization (TAE) for the hemostasis of pelvic fracture-related retroperitoneal hemorrhage were also analyzed.
  
  
  RESULTS
  There were 726 patients enrolled in current stud. Only 72.0% (523/726) of the patients who had major torso injuries were examined using PXRs, and 69.6% (505/726) of the patients underwent an abdominal/pelvic CT scan. For the patients who were examined using PXRs, there was no significant difference in the usage rate of an additional CT scan between the patients with positive (52.7%, 108/205) and negative (61.0%, 194/318) PXR examinations (P = .070). Four patients underwent TAE immediately following PXR examinations only, without a CT scan. These four patients had unstable pelvic fractures on the PXR examination and significantly a lower systolic blood pressure (61.0 ± 13.0 mmHg), a lower revised trauma score (3.560 ± 2.427), a greater requirement for blood transfusions (1750 ± 957.2 ml) than the patients who underwent TAE after a CT scan.
  
  
  CONCLUSIONS
  For the management of patients with major torso injuries, the role of PXR is diminishing due to the development of the CT scan. However, the PXR is still valuable for patients who are in critical condition and have an obviously high probability of retroperitoneal hemorrhaging.
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: drfu5564@yahoo.com.tw.
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fu
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: shangyusubmit@gmail.com.
authors.forename: Shang-Yu
authors.initials: SY
authors.lastname: Wang
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: yupao@cgmh.org.tw.
authors.forename: Yu-Pao
authors.initials: YP
authors.lastname: Hsu
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: gymetliao@gmail.com.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Liao
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: linbc@cgmh.org.tw.
authors.forename: Being-Chuan
authors.initials: BC
authors.lastname: Lin
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: sckang@adm.cgmh.org.tw.
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Kang
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: kcyuan@cgmh.org.tw.
authors.forename: Kuo-Ching
authors.initials: KC
authors.lastname: Yuan
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: m7017@cgmh.org.tw.
authors.forename: I-Ming
authors.initials: IM
authors.lastname: Kuo
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: DETV090@yahoo.com.tw.
authors.forename: Chun-Hsiang
authors.initials: CH
authors.lastname: Ouyang
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kwei Shan Township, Taoyuan, Taiwan. Electronic address: m7205@cgmh.org.tw.
authors.forename: Shang-Ju
authors.initials: SJ
authors.lastname: Yang
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D010388:Pelvis / Q000000981:diagnostic imaging* / Q000293:injuries; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D060726:Torso / Q000000981:diagnostic imaging / Q000293:injuries*