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

✍ Scribed by T. A. W. den Boer; M. Geurts; L. T. van Hulsteijn; A. Mubarak; J. Slingerland; B. Zwart; G. J. M. G. van der Heijden; T. J. Blokhuis

• Publisher: Springer
• Year: 2011
• Tongue: English
• Weight: 178 KB
• Volume: 37
• Category: Article
• ISSN: 1439-0590
• DOI: 10.1007/s00068-011-0076-7

✦ Synopsis

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.