title: Sacrum and Coccyx Radiographs Have Limited Clinical Impact in the Emergency Department.
abstract: OBJECTIVE
  The purpose of this study was to determine the yield and clinical impact of sacrum and coccyx radiographs in the emergency department (ED).
  
  
  METHODS
  Consecutive sacrum and coccyx radiographs obtained in the EDs of four hospitals over a 6-year period were categorized as positive for acute fracture or dislocation, negative, or other. Five follow-up metrics were analyzed: follow-up advanced imaging in the same ED visit, follow-up advanced imaging within 30 days, new analgesic prescriptions, clinic follow-up, and surgical intervention within 60 days.
  
  
  RESULTS
  Sacrum and coccyx radiographs from 687 patients (mean age, 48.1 years; 61.6% women and 38.4% men) obtained at level-1 (n = 335) and level-2 (n = 352) trauma centers showed a positivity rate of 8.4% ± 2.1% (n = 58/687). None of the 58 positive cases had surgical intervention. At the level-1 trauma centers, there was no significant association between sacrum and coccyx radiograph positivity and analgesic prescription or clinical follow-up (p = 0.12; odds ratio [OR], 2.3; 95% CI, 0.81-6.20). At the level-2 trauma centers, 97.1% (n = 34/35) of patients with positive sacrum and coccyx radiographs received analgesic prescriptions or clinical referrals, whereas negative cases were at 82.9% (OR, 7.0; 95% CI, 0.94-52.50). Of all cases, 5.7% (n = 39) and 4.3% (n = 29) had advanced imaging in the same ED visit and within 30 days, respectively. Sacrum and coccyx radiography results had no significant correlation with advanced imaging in the same ED visit (level-1, p = 0.351; level-2, p = 0.179). There was no significant difference in 30-day advanced imaging at the level-1 trauma centers (p = 0.8), but there was at the level-2 trauma centers (p = 0.0493).
  
  
  CONCLUSIONS
  ED sacrum and coccyx radiographs showed a low positivity rate and had no quantifiable clinical impact. We recommend that sacrum and coccyx radiographs be eliminated from ED practice and patients treated conservatively on the basis of clinical parameters.
authors: 1 Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University Midtown Hospital, 550 Peachtree Rd, Atlanta GA 30308.
authors: Tarek N
authors: TN
authors: Hanna
authors: 2 Morehouse School of Medicine, Atlanta, GA.
authors: Mahniya
authors: M
authors: Sadiq
authors: 1 Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University Midtown Hospital, 550 Peachtree Rd, Atlanta GA 30308.
authors: Noah
authors: N
authors: Ditkofsky
authors: 3 Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
authors: Marc
authors: M
authors: Benayoun
authors: 3 Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
authors: Abhijit
authors: A
authors: Datir
authors: 1 Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University Midtown Hospital, 550 Peachtree Rd, Atlanta GA 30308.
authors: Saurabh
authors: S
authors: Rohatgi
authors: 1 Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University Midtown Hospital, 550 Peachtree Rd, Atlanta GA 30308.
authors: Faisal
authors: F
authors: Khosa
mesh_terms: D000328:Adult; D000368:Aged; D003050:Coccyx / Q000000981:diagnostic imaging* / Q000293:injuries*; D004636:Emergency Service, Hospital; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D012447:Sacrum / Q000000981:diagnostic imaging* / Q000293:injuries*; D016103:Spinal Fractures / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: coccygodynia; coccyx; emergency department radiographs; sacrum