title: The Reliability of the Pre-hospital Physical Examination of the Pelvis: A Retrospective, Multicenter Study.
abstract: This study assesses the incidence of missed pelvic injuries in the pre-hospital setting.
  
  
  
  All blunt trauma patients (ISS ≥ 9) with pre-hospital suspicion of and/or radiologically proven pelvic fracture documented in the TraumaRegister DGU®(TR-DGU) of the German Trauma Society DGU (2002-2011) were identified and retrospectively analyzed. Patients with a missed pelvic injury in the pre-hospital period were compared with those who were correctly identified.
  
  
  
  Of the 11,062 patients included, 7201 patients (65.1 %) had a pelvic fracture diagnosed on hospital admission. In 44.1 % (n = 3178) of the patients with confirmed pelvic fracture, no pelvic injury was suspected pre-clinically (overall sensitivity of the pre-hospital pelvic examination: 55.9 %). For type B and C pelvic fractures, 40.5 % and 32.3 %, respectively, were not suspected in the pre-hospital environment. Patients with a not-suspected pelvic injury were significantly more likely to have been involved in a motor vehicle accident, to have a GCS ≤ 8, to be intubated at the scene and to have an ISS of ≥25 (all p < 0.05). Independent risk factors for missing a pelvic injury in the pre-hospital setting were an AIS head ≥3, a GCS ≤ 8 and age above 60 years. The presence of hypotension (SBP ≤ 90 mmHg) as well as a high overall injury severity (ISS ≥ 25) decreased the risk of missing a pelvic injury.
  
  
  
  A significant proportion of severe pelvic fractures type B and C were not suspected in the pre-hospital setting. Therefore, in severely injured blunt trauma patients, a mechanical pelvic stabilization in the pre-hospital environment, irrespective of the findings of the physical examination of the pelvis, should be considered.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University Frankfurt/Main, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany. tom.lustenberg@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lustenberger
authors.affiliation: Department of Trauma, University Hospital, Leipziger Str. 44, Magdeburg A.Ö.R., Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Walcher
authors.affiliation: Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.affiliation: Department of Trauma und Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt/Main, Frankfurt am Main, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Schweigkofler
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University Frankfurt/Main, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Wyen
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University Frankfurt/Main, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Marzi
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University Frankfurt/Main, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wutzler
mesh_terms: D015998:Abbreviated Injury Scale; D000063:Accidents, Traffic; D000328:Adult; D000367:Age Factors; D004632:Emergency Medical Services; D005188:False Negative Reactions; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D010808:Physical Examination; D012189:Retrospective Studies; D012307:Risk Factors; D014949:Wounds, Nonpenetrating / Q000150:complications*; D055815:Young Adult