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

Purpose of the study To evaluate the value of a pelvic X-ray compared to clinical examination in diagnosing pelvic ring fractures, using computed tomography (CT) as the gold standard, in alert [Glasgow Coma Scale (GCS) ≥ 13] adult blunt trauma patients in the emergency room. Methods A systematic lit...

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Bibliographic Details
Published in:European journal of trauma and emergency surgery (Munich : 2007) 2011-08, Vol.37 (4), p.373-377
Main Authors: den Boer, T. A. W., Geurts, M., van Hulsteijn, L. T., Mubarak, A., Slingerland, J., Zwart, B., van der Heijden, G. J. M. G., Blokhuis, T. J.
Format: Article
Language:English
Subjects:
Comparative studies
Critical Care Medicine
Emergency Medicine
Fractures
Intensive
Medical diagnosis
Medicine
Medicine & Public Health
Review
Review Article
Sports Medicine
Surgery
Surgical Orthopedics
Trauma care
Traumatic Surgery
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Summary:Purpose of the study To evaluate the value of a pelvic X-ray compared to clinical examination in diagnosing pelvic ring fractures, using computed tomography (CT) as the gold standard, in alert [Glasgow Coma Scale (GCS) ≥ 13] adult blunt trauma patients in the emergency room. Methods A systematic literature search was performed in PubMed and Embase. The results were screened on their titles and abstracts using in- and exclusion criteria. Subsequently, the selected articles were critically appraised for their relevance and validity. Results Two studies investigating the diagnostic value of clinical examination and pelvic X-ray compared to CT were identified. Both studies demonstrate higher negative predictive values for clinical examination [0.99 (95% confidence interval [CI] 0.98–1.0) and 1.0 (95% CI 0.99–1.0)] compared to the negative predictive values of pelvic X-ray [0.98 (95% CI 0.93–0.99) and 0.99 (95% CI 0.99–1.0)]. The positive predictive values for clinical examination were low [0.18 (95% CI 0.16–0.23) and 0.35 (95% CI 0.30–0.42)] compared to pelvic X-ray [0.97 (95% CI 0.96–0.98) and 0.97 (95% CI 0.90–0.99)]. Conclusions In alert blunt trauma patients, pelvic X-ray only has additional diagnostic value for the detection of pelvic ring fractures if the clinical examination is positive. Pelvic X-ray should not be performed if the clinical examination is negative. In this manner, the expenditure of time, costs, and radiation are optimized.
ISSN:1863-9933
1863-9941
DOI:10.1007/s00068-011-0076-7