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Necessity of Routine Pelvic Radiograph in the Pediatric Blunt Trauma Patient

Johns Hopkins Department of Pediatric Emergency Medicine Johns Hopkins University School of Medicine, dana.ramirez{at}chkd.org

Jennifer J. Schuette, MD

Johns Hopkins Department of Pediatric Emergency Medicine Johns Hopkins University School of Medicine

Vinita Knight, MPH

Johns Hopkins Department of Pediatric Surgery Johns Hopkins University School of Medicine

Elizabeth Johnson, MS

M. S. Bloomberg School of Public Health Johns Hopkins University School of Medicine

Justin Denise, BS

Johns Hopkins University Baltimore, Maryland

Allen R. Walker, MD

Johns Hopkins Department of Pediatric Emergency Medicine Johns Hopkins University School of Medicine

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.

Key Words: trauma • pelvic fracture • pelvic radiograph • pelvic X ray • pediatrics • pediatric trauma • pelvic injury • routine radiographs • pelvic injury • blunt trauma

This version was published on November 1, 2008

Clinical Pediatrics, Vol. 47, No. 9, 935-940 (2008)
DOI: 10.1177/0009922808320598


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