Pelvic X-rays routinely ordered for children who have suffered blunt force trauma do not effectively detect all instances of pelvic fractures or dislocations and are typically unwarranted for patients for whom abdominal/pelvic computed tomography (CT) scanning is otherwise planned. A recent study raises misgivings on a protocol that has been recommended by the Advanced Trauma Life Support Program (ATLS), considered the gold standard for trauma patients.
“Abdominal/pelvic CT is a superior diagnostic test compared to plain anteroposterior pelvic X-rays for diagnosing children with pelvic fractures or dislocations,” said lead study author Maria Kwok, MD, MPH, from Columbia University Medical Center (New York, NY, USA). “Because of concerns about lifetime exposure to radiation in children, appropriate use of radiography is important. We just could not find enough accuracy or utility to justify the pelvic X-ray for most of these children.”
Plain pelvic radiographs had a sensitivity of only 78% for identifying patients with pelvic fractures or dislocations. Of the patients not accurately identified as having pelvic fractures or dislocations, 98% were correctly detected by abdominal/pelvic CT scans. Standard pelvic X-rays are helpful only for hemodynamically unstable patients and for hemodynamically stable patients who the physician believes may have dislocations or pelvic fractures but who are not otherwise undergoing abdominal/pelvic CT scanning.
The highest risk for dislocations or pelvis fractures included bicyclists or pedestrians struck by moving vehicles and injuries involving motor vehicle collisions. Low-level falls or bicycle accidents were seldom diagnosed with pelvic fractures or dislocations. None of the 281 patients in the study who fell down stairs were diagnosed with pelvic fractures or dislocations.
“CT scanning should not be used as a primary screening tool if no clinical evidence of pelvic fracture or dislocation exists,” said Dr. Kwok. “A physical examination and clinical judgment are still the first line in determining which patients need advanced imaging and which can safely skip it.”
The study’s findings were published online July 29, 2014, in the journal Annals of Emergency Medicine.
Columbia University Medical Center