title: The selection of diagnostic modalities in the management of pelvic fracture patients requiring transfers.
abstract: BACKGROUND
  Pelvic fractures can result in life-threatening hemorrhages. Therefore, pelvic fracture patients must usually be transferred to a trauma center for additional management. We attempted to analyze transferred pelvic fracture patients to determine which diagnostic modalities to use in different treatment settings.
  
  
  METHODS
  From May 1, 2008, to February 28, 2014, patients with pelvic fractures who were transferred from other local hospitals within 24 hours after the trauma were enrolled. We compared the pre-transfer conditions and pelvic X-ray results from the local hospitals between the group of patients that underwent further angioembolization at the trauma center and the group that did not. The role of computed tomography (CT) in the decision-making process (i.e., regarding additional angioembolization) at the different institutions was discussed.
  
  
  RESULTS
  In total, 751 patients were enrolled in the current study. Of the patients who received further angioembolization at the trauma center, 77.6 % (121/156) had sacro-iliac (SI) joint disruption on their pre-transfer pelvic X-ray; this rate was significantly higher than that of the patients who did not undergo further embolization (77.6 % vs. 25.5 %, p < 0.001). There was no significant difference in the use of pre-transfer CT scans at the local hospitals between the patients who underwent angioembolization and those who did not (53.8 % vs. 50.3 %, p = 0.472). Furthermore, of these patients, there was no significant difference in the length of emergency department stay (from arrival to angioembolization) at the trauma center among the patients who underwent pre-transfer CT scans and those who did not (97.4 ± 69.3 minutes vs. 108.6 ± 21.8 minutes, p = 0.461).
  
  
  CONCLUSIONS
  When managing patients with pelvic fractures, the more attention should be paid to those with SI joint disruption on pelvic X-ray. Because these patients are more likely to require further angioembolization, they should be transferred earlier. Additional CT may be performed after the patient's transfer to the trauma center to determine subsequent treatment.
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan, Taiwan.
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, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan, Taiwan.
authors.forename: Shang-Ju
authors.initials: SJ
authors.lastname: Yang
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan, Taiwan.
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, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan, Taiwan.
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, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan, Taiwan.
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, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan, Taiwan.
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, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan, Taiwan.
authors.forename: Yu-Pao
authors.initials: YP
authors.lastname: Hsu
keywords: Pelvic X-ray; Pelvic fracture; Sacroiliac joint disruption; Transfer