Importance of Pelvic Radiography for Initial Trauma Assessment: An Orthopedic Perspective

Diederik O. Verbeek, Andrew R. Burgess

Research output: Contribution to journalArticle

Abstract

Background: Many institutions have abandoned the routine for selective pelvic x-ray (PXR) for initial imaging in blunt trauma patients undergoing computed tomography (CT) scanning. Objective: Our aim was to examine the association between selective use of PXR and time to diagnosis of (major) pelvic fractures, as well as prioritization of key immediate interventions (including hip reduction and pelvic arterial embolization). Methods: We conducted a 1-year review of early management of pelvic fracture patients undergoing pelvic CT scanning. Time interval and sequence of initial imaging and key immediate interventions were recorded. Results: Of 218 pelvic fracture patients, 79 (36%) had no initial PXR, and instead had an initial CT scan. Time to first pelvic imaging in those patients was 48 min (standard deviation [SD] = 47 min vs. 2 min [SD = 6 min] with PXR; p <0.001). Of 40 hip dislocations, 15 (38%) were detected first on CT scan. Overall, 22 (55%) required a second CT scan after reduction in the emergency department. No initial PXR was performed in 42 of 120 (35%) pelvic ring fracture patients and in 16 of 61 (26%) unstable pelvic ring fractures. Time to pelvic arterial embolization was longer in 4 patients without initial PXR than in 14 patients with PXR (296 min [SD = 206 min] vs. 170 min [SD = 76 min], respectively, p = 0.038). Conclusions: Selective PXR was associated with a significant delay in recognition of (major) pelvic fractures, including those with associated hip dislocations and (potential) pelvic bleeding. PXR remains a useful screening tool to rapidly determine the need for immediate interventions and to allow early planning before CT scanning.

Original languageEnglish (US)
JournalJournal of Emergency Medicine
DOIs
StateAccepted/In press - Nov 4 2014
Externally publishedYes

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Radiography
Orthopedics
X-Rays
Wounds and Injuries
Tomography
Hip Dislocation
Hospital Emergency Service
Hip
Hemorrhage

Keywords

  • Acetabular fracture
  • Computed tomography
  • Pelvic fracture
  • Pelvic radiography

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Importance of Pelvic Radiography for Initial Trauma Assessment : An Orthopedic Perspective. / Verbeek, Diederik O.; Burgess, Andrew R.

In: Journal of Emergency Medicine, 04.11.2014.

Research output: Contribution to journalArticle

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abstract = "Background: Many institutions have abandoned the routine for selective pelvic x-ray (PXR) for initial imaging in blunt trauma patients undergoing computed tomography (CT) scanning. Objective: Our aim was to examine the association between selective use of PXR and time to diagnosis of (major) pelvic fractures, as well as prioritization of key immediate interventions (including hip reduction and pelvic arterial embolization). Methods: We conducted a 1-year review of early management of pelvic fracture patients undergoing pelvic CT scanning. Time interval and sequence of initial imaging and key immediate interventions were recorded. Results: Of 218 pelvic fracture patients, 79 (36{\%}) had no initial PXR, and instead had an initial CT scan. Time to first pelvic imaging in those patients was 48 min (standard deviation [SD] = 47 min vs. 2 min [SD = 6 min] with PXR; p <0.001). Of 40 hip dislocations, 15 (38{\%}) were detected first on CT scan. Overall, 22 (55{\%}) required a second CT scan after reduction in the emergency department. No initial PXR was performed in 42 of 120 (35{\%}) pelvic ring fracture patients and in 16 of 61 (26{\%}) unstable pelvic ring fractures. Time to pelvic arterial embolization was longer in 4 patients without initial PXR than in 14 patients with PXR (296 min [SD = 206 min] vs. 170 min [SD = 76 min], respectively, p = 0.038). Conclusions: Selective PXR was associated with a significant delay in recognition of (major) pelvic fractures, including those with associated hip dislocations and (potential) pelvic bleeding. PXR remains a useful screening tool to rapidly determine the need for immediate interventions and to allow early planning before CT scanning.",
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