title: Sensitivity of plain pelvis radiography in children with blunt torso trauma.
abstract: OBJECTIVE
  Plain anteroposterior pelvic radiographs are commonly used to screen children for pelvic fractures or dislocations after blunt torso trauma. The test sensitivity and utility, however, are unclear. We assessed the sensitivity of anteroposterior pelvic radiographs for identifying children with pelvic fractures or dislocations after blunt torso trauma. We hypothesized that anteroposterior pelvic radiographs fail to identify all children with pelvic fractures or dislocations, including patients undergoing operative intervention and those with hypotension.
  
  
  METHODS
  We conducted a prospective multicenter observational study of children (<18 years) with blunt torso trauma in the Pediatric Emergency Care Applied Research Network. We compared plain anteroposterior pelvic radiographs to the final diagnosis of pelvic fractures or dislocations as documented by the orthopedic faculty physician before emergency department (ED)/hospital discharge. We described the data with descriptive statistics, including 95% confidence intervals (CIs).
  
  
  RESULTS
  Of 12,044 patients enrolled in the parent study, 451 (3.7%; 95% CI 3.4% to 4.1%) had pelvic fractures or dislocations. Of these patients, 65 (14%; 95% CI 11% to 18%) underwent operative intervention and 21 (4.7%; 95% CI 2.9% to 7.0%) had age-adjusted hypotension on initial presentation. In the ED, 382 of the 451 patients underwent plain anteroposterior pelvic radiographs, with a sensitivity of 297 of 382 (78%; 95% CI 73% to 82%) for patients with pelvic fractures or dislocations, 55 of 60 (92%; 95% CI 82% to 97%) for patients undergoing operative intervention, and 14 of 17 (82%; 95% CI 57% to 96%) for patients with hypotension.
  
  
  CONCLUSIONS
  Plain anteroposterior pelvic radiographs have a limited sensitivity for identifying children with pelvic fractures or dislocations after blunt trauma, including patients undergoing operative intervention and those with hypotension.
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY. Electronic address: myk2102@cumc.columbia.edu.
authors.forename: Maria Y
authors.initials: MY
authors.lastname: Kwok
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Ken
authors.initials: K
authors.lastname: Yen
authors.affiliation: Department of Pediatrics, Children's National Medical Center, Washington, DC.
authors.forename: Shireen
authors.initials: S
authors.lastname: Atabaki
authors.affiliation: Department of Pediatrics, Children's Hospital Colorado, Aurora, CO.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Adelgais
authors.affiliation: Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.
authors.forename: Madelyn
authors.initials: M
authors.lastname: Garcia
authors.affiliation: Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Quayle
authors.affiliation: Department of Pediatrics, Helen DeVos Children's Hospital, Grand Rapids, MI.
authors.forename: Joshua
authors.initials: J
authors.lastname: Kooistra
authors.affiliation: Department of Pediatrics, Nationwide Children's Hospital, Columbia, OH.
authors.forename: Bema K
authors.initials: BK
authors.lastname: Bonsu
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, UT.
authors.forename: Kent
authors.initials: K
authors.lastname: Page
authors.affiliation: Department of Emergency Medicine, Hurley Medical Center, Flint, MI, and Department of Emergency Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Dominic
authors.initials: D
authors.lastname: Borgialli
authors.affiliation: Department of Emergency Medicine, University of California, Davis, Sacramento, CA; Department of Pediatrics, University of California, Davis, Sacramento, CA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
authors.affiliation: Department of Emergency Medicine, University of California, Davis, Sacramento, CA.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging; D006617:Hip Dislocation / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D008297:Male; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries; D010388:Pelvis / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*