Necessity of routine pelvic radiograph in the pediatric blunt trauma patient

Background: Pelvic radiographs are obtained frequently in pediatric blunt trauma. The authors hypothesize that there are clinical indicators that can predict pelvic fracture on a pelvic radiograph in the pediatric blunt trauma patient with a Glasgow Coma Scale score of 14 or 15. Methods: A retrospective case-control study of 33 patients with pelvic fractures and 63 patients without pelvic fractures was performed. Results: 8 evaluated clinical indicators showed that pelvic contusions and abrasions (P =.026), hip/pelvic pain (P<.001), abdominal pain and distension (P =.006), back pain (P =.080), hip held in rotation at presentation (P =.026), and femur deformity/pain (P =.002) were independently predictive of pelvic fracture. In combination, absence of hip/pelvic pain, pelvic contusions and abrasions, abdominal pain/distension, and femur deformity/pain showed a negative predictive value of 87%. Conclusion: Clinical indicators may be useful in determining the need for pelvic radiographs in awake and alert pediatric blunt trauma patients.