Skip to main content

Are routine pelvic radiographs in major pediatric blunt trauma necessary?

Pediatric Radiology volume 42, pages 853–858 (2012)Cite this article

Abstract

Background

Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children.

Objective

To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma.

Materials and methods

We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture.

Results

Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52–52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS <14, positive urinalysis, abdominal pain/tenderness, femur fracture) and five high-risk mechanisms of injury (unrestrained motor vehicle collision [MVC], MVC with ejection, MVC rollover, auto vs. pedestrian, auto vs. bicycle).

Conclusion

Pelvic fractures in pediatric major blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Arias E, MacDorman MF, Strobino DM et al (2003) Annual summary of vital statistics. Pediatrics 112:1215–1230

    PubMed  Article  Google Scholar 

  2. Danesco ER, Miller TR, Spicer RS (2000) Incidence and costs of 1987–1994 childhood injuries: demographic breakdowns. Pediatrics 105:E27

    Article  Google Scholar 

  3. Committee on Trauma (2008) ATLS: advanced trauma life support for doctors, 8th edn. American College of Surgeons, Chicago

    Google Scholar 

  4. Rothenberger DA, Fischer RP, Strate RG et al (1978) The mortality associated with pelvic fractures. Surgery 84:356–361

    PubMed  CAS  Google Scholar 

  5. Wolinsky PR (1997) Assessment and management of pelvic fracture in the hemodynamically unstable patient. Orthop Clin N Am 28:321–329

    Article  CAS  Google Scholar 

  6. Agnew SG (1994) Hemodynamically unstable pelvic fractures. Orthop Clin N Am 25:715–721

    CAS  Google Scholar 

  7. Patterson FP, Morton KS (1973) The cause of death in fractures of the pelvis: with a note on treatment by ligation of the hypogastric (internal iliac) artery. J Trauma 13:849–856

    PubMed  CAS  Google Scholar 

  8. Silber J, Flynn J, Koffler K et al (2001) Analysis of the cause, classification, and associated injuries of 166 consecutive pediatric pelvic fractures. J Pediatr Orthop 21:446–450

    PubMed  Article  CAS  Google Scholar 

  9. Tarman GJ, Kaplan GW, Lerman SL et al (2002) Lower genitourinary injury and pelvic fractures in pediatric patients. Urology 59:123–126

    PubMed  Article  Google Scholar 

  10. Ismail N, Bellemare JF, Mollitt DL et al (1996) Death from pelvic fracture: children are different. J Pediatr Surg 31:82–85

    PubMed  Article  CAS  Google Scholar 

  11. Bond S, Gotschall CS, Eichelberger MR (1991) Predictors of abdominal injury in children with pelvic fracture. J Trauma 31:1169–1173

    PubMed  CAS  Google Scholar 

  12. Demetriades D, Karaiskakis M, Velmajos GC et al (2003) Pelvic fractures in pediatric and adult trauma patients: are they different injuries? J Trauma 54:1146–1151

    PubMed  Article  Google Scholar 

  13. Guillamondegui OD, Mahboubi S, Stafford PW et al (2003) The utility of the pelvic radiograph in the assessment of pediatric pelvic fractures. J Trauma 55:236–240

    PubMed  Article  Google Scholar 

  14. Junkins EP, Furnival RA, Bolte RG (2001) The clinical presentation of pediatric pelvic fractures. Pediatr Emerg Care 17:15–18

    PubMed  Article  CAS  Google Scholar 

  15. Junkins EP, Nelson DS, Carroll KL et al (2001) A prospective evaluation of the clinical presentation of pediatric pelvic fractures. J Trauma 51:64–68

    PubMed  Article  Google Scholar 

  16. Salvino CK, Esposito TJ, Smith D et al (1992) Routine pelvic x-rays studies in awake blunt trauma patients: a sensible policy? J Trauma 33:413–416

    PubMed  Article  CAS  Google Scholar 

  17. Gonzalez RP, Fried PQ, Bukhalo M (2002) The utility of clinical examination in screening for pelvic fractures in blunt trauma. J Am Coll Surg 194:121–125

    PubMed  Article  Google Scholar 

  18. Ramirez DW, Schuette JJ, Knight V et al (2008) Necessity of routine pelvic radiograph in the pediatric blunt trauma patient. Clin Pediatr 47:935–940

    Article  Google Scholar 

  19. Wong AT, Brady KB, Caldwell A et al (2011) Low-risk criteria for pelvic radiography in pediatric blunt trauma patients. Pediatr Emerg Care 27:92–96

    PubMed  Article  Google Scholar 

  20. Nabaweesi RM, Arnold MA, Chang DC et al (2008) Prehospital predictors of risk for pelvic fractures in pediatric trauma patients. Pediatr Surg Int 24:1053–1056

    PubMed  Article  Google Scholar 

  21. Obaid AK, Barleben A, Perral D et al (2006) Utility of plain film pelvic radiographs in blunt trauma patients in the emergency department. Am Surg 72:951–954

    PubMed  Google Scholar 

  22. Soundappan S, Smith NF, Lam LT et al (2006) A trauma series in the injured child: do we really need it? Pediatr Emerg Care 22:710–716

    PubMed  Article  Google Scholar 

  23. Kevill K, Wong AM, Goldman HS et al (2002) Is a complete trauma series indicated for all pediatric trauma victims? Pediatr Emerg Care 18(2):75–77

    PubMed  Article  Google Scholar 

  24. Rees MJ, Aickin R, Kolbe A et al (2001) The screening pelvic radiograph in pediatric trauma. Pediatr Radiol 31:497–500

    PubMed  Article  CAS  Google Scholar 

  25. Ersoy G, Karcioglu O, Enginbas Y et al (1995) Should all patients with blunt trauma undergo ‘routine’ pelvic x-ray? Eur J Emerg Med 2:65–68

    PubMed  Article  CAS  Google Scholar 

  26. Kharasch SJ, Vinci RJ, Hirsch E et al (1994) The routine use of radiography and arterial blood gases in the evaluation of blunt trauma in children. Ann Emerg Med 23:212–215

    PubMed  Article  CAS  Google Scholar 

  27. Koury HI, Peschiera JL, Welling RE (1993) Selective use of pelvic roentgenograms in blunt trauma patients. J Trauma 34:236–237

    PubMed  Article  CAS  Google Scholar 

  28. Almen A, Mattsson S (1995) The radiation dose to children from X-ray examinations of the pelvis and the urinary tract. Br J Radiol 68:604–613

    PubMed  Article  CAS  Google Scholar 

  29. Brenner DJ, Elliston CD, Hall EJ et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR 176:289–296

    PubMed  CAS  Google Scholar 

  30. Williams MJ, Lockey AS, Culshaw MC (1997) Improved trauma management with advanced trauma life support (ATLS) training. J Accid Emerg Med 14:81–83

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Affiliations

  1. Emergency Medicine Department, Memorial Hermann Medical Center, Houston, TX, USA

    Jyothi Lagisetty

  2. Department of Radiology, Pediatric Imaging, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA

    Thomas Slovis

  3. Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University of Medicine, Detroit, MI, USA

    Ronald Thomas

  4. Division of Emergency Medicine, Children’s Hospital of Michigan, Wayne State University of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201, USA

    Stephen Knazik & Curt Stankovic

Authors
  1. Jyothi Lagisetty
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas Slovis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ronald Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephen Knazik
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Curt Stankovic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Curt Stankovic.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lagisetty, J., Slovis, T., Thomas, R. et al. Are routine pelvic radiographs in major pediatric blunt trauma necessary?. Pediatr Radiol 42, 853–858 (2012). https://doi.org/10.1007/s00247-011-2341-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-011-2341-7

Keywords

  • Pelvic fracture
  • Pelvic trauma
  • Pediatrics
  • Imaging
  • Risk factors