Most kids with blunt torso trauma can skip the pelvic X-ray

August 6, 2014

Pelvic x-rays ordered as a matter of course for children who have suffered blunt force trauma do not accurately identify all cases of pelvic fractures or dislocations and are usually unnecessary for patients for whom abdominal/pelvic CT scanning is otherwise planned. A study published online in Annals of Emergency Medicine last week casts doubt on a practice that has been recommended by the Advanced Trauma Life Support Program (ATLS), considered the gold standard for trauma patients (Sensitivity of Plain Pelvis Radiography in Children with Blunt Torso Trauma).

"Abdominal/pelvic CT is a superior diagnostic test compared to plain anteroposterior pelvic x-rays for diagnosing children with or dislocations," said lead study author Maria Kwok, MD, MPH, of Columbia University Medical Center in New York, N.Y. "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 x-rays had a sensitivity of only 78 percent for identifying with pelvic fractures or dislocations. Of the patients not correctly identified as having pelvic fractures or dislocations, 98 percent were correctly diagnosed by abdominal/pelvic CT scans.

Plain pelvic x-rays are useful only for hemodynamically unstable patients and for hemodynamically stable patients who the physician believes may have pelvic fractures or dislocations but who are not otherwise undergoing abdominal/pelvic CT scanning.

The highest risk for pelvic fractures or dislocations included pedestrians or bicyclists struck by moving vehicles and injuries involving motor vehicle collisions. Low-level falls or bicycle accidents were rarely 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."

Explore further: Female triathletes at risk for pelvic floor disorders and other complications

Related Stories

Recommended for you

Zika virus infection alters human and viral RNA

October 20, 2016

Researchers at University of California San Diego School of Medicine have discovered that Zika virus infection leads to modifications of both viral and human genetic material. These modifications—chemical tags known as ...

Food-poisoning bacteria may be behind Crohn's disease

October 19, 2016

People who retain a particular bacterium in their gut after a bout of food poisoning may be at an increased risk of developing Crohn's disease later in life, according to a new study led by researchers at McMaster University.

Neurodevelopmental model of Zika may provide rapid answers

October 19, 2016

A newly published study from researchers working in collaboration with the Regenerative Bioscience Center at the University of Georgia demonstrates fetal death and brain damage in early chick embryos similar to microcephaly—a ...

Scientists uncover new facets of Zika-related birth defects

October 17, 2016

In a study that could one day help eliminate the tragic birth defects caused by Zika virus, scientists from the Florida campus of The Scripps Research Institute (TSRI) have elucidated how the virus attacks the brains of newborns, ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.