The value of clinical examination in diagnosing pelvic fractures in blunt trauma patients: a brief review

Background: Blunt trauma abdomen is a common surgical emergency which may present as an isolated problem or as a part of poly trauma. Road traffic (automobile) accident is the most common cause of blunt trauma abdomen.Methods: After initial resuscitation and achieving hemodynamic stability, all patients were subjected to careful history and clinical examination. Depending on the clinical findings, decision for further investigations as four-quadrant aspiration, X-ray of chest and abdomen erect view and abdominal ultrasound were taken. The decision to operate or non-operative management depended on the outcome of clinical examination and results of diagnostic tests.Results: This is a clinical study of 100 patients who were admitted, treated and followed up in Gauhati Medical College and Hospital, Guwahati, Assam, India from 1st July, 2015 to 30th June, 2016. In this study, the incidence of blunt trauma abdomen was found to be 69.78% out of all abdominal trauma patients. The most common cause was found to be road traffic accidents (67%). The commonest age group was 21 to 30 years comprises about 39% of patients. The average age was 30.82 years. Spleen was the most common organ involved (44%). 53.52% of patient having solid organ injured was managed conservatively. Out of 60 operative cases, 25 (41.7%) cases were operated within 3-6 hours.Conclusions: Patients with blunt trauma abdomen should have early and accurate diagnosis and prompt, proper and prudent management to improve overall prognosis.

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EARLY IDENTIFICATION OF ACTIVE ARTERIAL HEMORRHAGE IN HYPOTENSIVE BLUNT TRAUMA PATIENTS WITH PELVIC FRACTURES

Critical Care Medicine ◽

10.1097/00003246-199801001-00080 ◽

1998 ◽

Vol 26 (Supplement) ◽

pp. 46A

Author(s):

C. Michael Buechler ◽

Paul Blostern ◽

Michael Kasten ◽

David Ritzo

Keyword(s):

Blunt Trauma ◽

Early Identification ◽

Pelvic Fractures ◽

Trauma Patients ◽

Arterial Hemorrhage

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Utility of Plain Film Pelvic Radiographs in Blunt Trauma Patients in the Emergency Department

The American Surgeon ◽

10.1177/000313480607201025 ◽

2006 ◽

Vol 72 (10) ◽

pp. 951-954 ◽

Cited By ~ 13

Author(s):

Amal Kamil Obaid ◽

Andrew Barleben ◽

Diana Porral ◽

Stephanie Lush ◽

Marianne Cinat

Keyword(s):

Emergency Department ◽

Ct Scan ◽

Blunt Trauma ◽

Injury Severity ◽

Plain Film ◽

Pelvic Fractures ◽

Trauma Patients ◽

Pelvic Radiographs ◽

Highly Sensitive ◽

Pelvic Embolization

The objective of this study was to evaluate the utility and sensitivity of routine pelvic radiographs (PXR) in the initial evaluation of blunt trauma patients. A retrospective review was performed. One hundred seventy-four patients with a pelvic fracture who had computed tomography (CT) and PXR were included (average age, 36.1; average Injury Severity Score, 16.3). Nine (5%) patients died. Five hundred twenty-one fractures were identified on CT. One hundred sixteen (22%) of these fractures were missed by PXR. Eighty-eight (51%) patients were underdiagnosed by PXR alone. The most common fractures missed by PXR were sacral and iliac fractures. Eight patients required angiograms, with four undergoing therapeutic pelvic embolization. Forty-seven (27%) patients were hypotensive or required a transfusion in the emergency department. These patients were more likely to require an angiogram (17% vs 0%, P < 0.0001) and were more likely to require embolization (9% vs 0%, P < 0.001). This study demonstrates that CT scan is highly sensitive in identifying and classifying pelvic fractures. PXR has a sensitivity of only 78 per cent for identification of pelvic fractures in the acute trauma patient. In hemodynamically stable patients who are going to undergo diagnostic CT scan, PXR is of little value. The greatest use of PXR may be as a screening tool in hemodynamically unstable patients and/or those that require transfusion to allow for early notification of the interventional radiology team.

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How (Un)useful is the Pelvic Ring Stability Examination in Diagnosing Mechanically Unstable Pelvic Fractures in Blunt Trauma Patients?

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2009.06.122 ◽

2009 ◽

Vol 37 (3) ◽

pp. 351 ◽

Cited By ~ 1

Author(s):

Shay Krier

Keyword(s):

Blunt Trauma ◽

Pelvic Ring ◽

Pelvic Fractures ◽

Trauma Patients ◽

Stability Examination ◽

Ring Stability

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Diagnostic Accuracy of Physical Examination for Detecting Pelvic Fractures Among Blunt Trauma Patients: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-62425/v1 ◽

2020 ◽

Author(s):

Yohei Okada ◽

Norihiro Nishioka ◽

Shigeru Ohtsuru ◽

Yasushi Tsujimoto

Keyword(s):

Systematic Review ◽

Physical Examination ◽

Diagnostic Accuracy ◽

Blunt Trauma ◽

Pelvic Fracture ◽

Clinical Utility ◽

Meta Analysis ◽

Pelvic Fractures ◽

Trauma Patients ◽

Threshold Probability

Abstract Background: Pelvic fractures are common among blunt trauma patients, and timely and accurate diagnosis can improve patient outcomes. However, it remains unclear whether physical examinations are sufficient in this context. This study aims to perform a systematic review and meta-analysis of studies on the diagnostic accuracy and clinical utility of physical examination for pelvic fracture among blunt trauma patients.Methods: Studies were identified using the MEDLINE, EMBASE, and CENTRAL databases starting from the creation of the database to January 2020. A total of 20 studies (49,043 patients with 8,300 cases [16.9%] of pelvic fracture) were included in the quality assessment and meta-analysis. Two investigators extracted the data and evaluated the risk of bias in each study. The meta-analysis involved a hierarchical summary receiver operating curve (ROC) model to calculate the diagnostic accuracy of the physical exam. Subgroup analysis assessed the extent of between-study heterogeneity. Clinical utility was assessed using decision curve analysis.Results: The median prevalence of pelvic fracture was 10.5% (interquartile range: 5.1–16.5). The pooled sensitivity (and corresponding 95% confidence interval) of the hierarchical summary ROC parameters was 0.859 (0.761–0.952) at a given specificity of 0.920, which was the median value among the included studies. Subgroup analysis revealed that the pooled sensitivity among patients with a Glasgow Coma Scale score ≥ 13 was 0.933 (0.847–0.998) at a given specificity of 0.920. The corresponding value for patients with scores ≤ 13 was 0.761 (0.560–0.932). For threshold probability < 0.01 with 10%–15% prevalence, the net benefit of imaging tests was higher than that of physical examination. Conclusion: Imaging tests should be performed in all trauma patients regardless of findings from physical examination or patients’ levels of consciousness. However, the clinical role of physical examination should be considered given the prevalence and threshold probability in each setting.

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Clinical Examination is Superior to Plain Films to Diagnose Pelvic Fractures Compared to CT

The American Surgeon ◽

10.1177/000313480807400604 ◽

2008 ◽

Vol 74 (6) ◽

pp. 476-480 ◽

Cited By ~ 13

Author(s):

TherÈSe M. Duane ◽

Tracey Dechert ◽

Luke G. Wolfe ◽

Holly Brown ◽

Michel B. Aboutanos ◽

...

Keyword(s):

Glasgow Coma Scale ◽

Negative Predictive Value ◽

Blunt Trauma ◽

Clinical Examination ◽

Glasgow Coma Scale Score ◽

Predictive Value ◽

Screening Tool ◽

Pelvic Fractures ◽

Plain Films ◽

The Right

We prospectively compared clinical examination (CE) with plain films (PXR) and both tools with CT in patients sustaining blunt trauma. There were 1388 patients who had both PXR and CT of whom 168 (12.1%) were diagnosed with a fracture by CT. CE findings most predictive of fracture included age (OR, 1.025; CI, 1.011–1.039), hip pain (OR, 4.971; CI, 2.508–9.854), internal rotation of the leg (OR, 4.880; CI, 1.980–12.027), or tenderness to palpation over the sacrum (OR, 2.297; CI, 1.144–4.612), over the right or left hip (OR, 3.626; CI, 1.823–7.214), or diffusely throughout the pelvis (OR, 16.445; CI, 4.277–63.237). These factors were still predictive of pelvic fractures even in patients with a Glasgow Coma Scale score less than 13. There were 136 fractures identified by PXR all of which were identified by CE (sensitivity 100% [136 of 136], negative predictive value 100% [619 of 619]). There were six patients with negative clinical examinations and positive CTs (sensitivity 96.4% [162 of 168], negative predictive value 99.03% [613 of 619]), none of which were hemodynamically significant. The sensitivity for PXR compared with CT was 79.17 per cent (133 of 168) and the NPV was 97.2 per cent (1217 of 1252). CE is a reliable way to diagnose pelvic fractures and PXR is a poor screening tool for these injuries compared with CT. Because the majority of patients undergo CT after blunt trauma, routine screening radiographs should be eliminated.

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