Abstract
to identify a subgroup of blunt trauma patients with very low chance of sustaining pelvic fractures based on clinical criteria. retrospective analysis of the trauma registry data, collected in a period of 24 months. We selected adult blunt trauma patients who had a PXR on admission. The frequency of pelvic fractures was calculated for the following groups: Normal neurological examination at admission (NNE), hemodynamical stability (HS), normal pelvic examination at admission (NPE), less than 60 years old (ID<60) and absence of distracting injuries (ADI). Logistic regression analysis was carried out in order to create a probability model of negative PXR. an abnormal PXR was identified in 101 (3.3%) out of the 3,055 patients who had undergone a PXR at admission. Out of these, 1,863 sustained a NNE, with 38 positive CXRs (2.0%) in this group. Considering only the 1,535 patients with NNE and HS, we found 28 positive PXRs (1.8%). Out of these, 1,506 have NPE, with 21 abnormal PXRs (1.4%). Of these, 1,202 were younger than 60 y, with 11 positive PXRs (0.9%). By adding all these criteria to the ADI, we found 2 abnormal PXRs in 502 (0.4%) cases. The probability model including all these variables had a 0,89 area under the ROC curve. by adding clinical criteria, it is possible to identify a group of trauma patients with very low chance of sustaining pelvic fractures. The necessity of PXR in these patients needs to be reassessed.
Highlights
Around 3% of all bone fractures are in the pelvis[1]
101 patients (3.3%) had fractures of the pelvis identified at the admission X-Ray
Pelvic fractures can be considered as a marker of severe trauma[8,19]
Summary
Around 3% of all bone fractures are in the pelvis[1]. Of the victims of blunt trauma admitted to hospitals, 9.3% have pelvic fractures[2]. The guidelines of the Advanced Trauma Life Support (ATLS) recommend that the simple radiography of the anteroposterior pelvis be performed systematically on victims of severe blunt trauma upon admission to the trauma room[10]. The advantage of such conduct would be precisely the early identification of patients who need some form of hemostasis, such as external fracture fixation, extra-peritoneal pelvic tamponade and/or embolization by angiography[11,12,13,14,15]. Diagnosis would decrease time to treatment and blood loss, which is essential for a better prognosis
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