title: Pelvic Ring Fractures: Utility of Clinical Examination in Patients with Impaired Consciousness or Tracheal Intubation.
abstract: OBJECTIVE
  To define the diagnostic accuracy of clinical examination in patients with impaired consciousness or endotracheal intubation to detect pelvic ring fractures and to identify those with severe bleeding.
  
  
  METHODS
  Included in this prospective data collection with retrolective data analysis were a consecutive series of blunt trauma victims with either a Glasgow Coma Scale ≤ 13 or tracheal intubation. Clinical examination comprised testing for stability of the iliac wings.
  
  
  RESULTS
  From 784 subjects (injury severity score 23.3 ± 17.4) 93 patients (11.9%) were found to have a pelvic ring fracture. Clinical instability of the pelvic ring was found in 42 patients. There was only one false positive. Fifty-two fractures could not be identified by clinical examination, including nine fractures (17%) that required surgical fracture stabilization (sensitivity of clinical examination 44.1%). Seventeen fractures (18.3%) were associated with a blood loss larger than 20% of circulating blood volume. Sixteen of those were identified by clinical instability of the pelvic ring (sensitivity 94.1%, specificity 97.0%, positive predictive value 38.1%, negative predictive value 99.9%).
  
  
  CONCLUSIONS
  Clinical examination for stability of the pelvis in this selected group of patients missed a significant number of pelvic ring fractures including fractures that require surgical stabilization. The finding of a clinically unstable identifies most of the patients with the pelvic ring fracture being a major source of bleeding. A stable pelvis makes pelvic ring fracture as being the source of bleeding quite unlikely.
authors.affiliation: Department of Trauma Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany. christian.waydhas@uk-essen.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Waydhas
authors.forename: Dieter
authors.initials: D
authors.lastname: Nast-Kolb
authors.affiliation: Department of Trauma Surgery, University Hospital Essen, Essen, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Ruchholtz
keywords: Adult; Hemorrhage; Pelvic fracture; Trauma