Which pediatric blunt trauma patients do not require pelvic imaging?

J Trauma Acute Care Surg. 2015 Nov;79(5):828-32. doi: 10.1097/TA.0000000000000848.

Abstract

Background: This study aimed to develop a tool in identifying traumatized children at low risk of pelvic fracture and to determine the sensitivity of this low-risk model for pelvic fractures. We hypothesized that the proportion of children without predictors with pelvic fracture is less than 1%.

Methods: This is a retrospective trauma registry analysis of previously healthy children 1 year to 17 years old presenting to the pediatric emergency department with blunt trauma. Postulated predictors of pelvic fracture on radiograph or computed tomography included pain/abnormal examination result of the pelvis/hip, femur deformity, hematuria, abdominal pain/tenderness, Glasgow Coma Scale (GCS) score of 13 or lower, and hemodynamic instability. We used multivariable logistic regression to identify independent predictors of fracture.

Results: Of 1,121 eligible patients (mean [SD] age, 8.5 [4.6] years), 87 (7.8%) had pelvic fracture. Independent predictors included pain/abnormal examination result of the pelvis/hip (odds ratio [OR], 16.7; 95% confidence interval [CI], 9.6-29.1), hematuria (OR, 6.6; 95% CI, 3.0-14.6), femoral deformity (OR, 5.9; 95% CI, 3.1-11.3), GCS score of 13 or lower (OR, 2.4; 95% CI, 1.3-4.3), and hemodynamic instability (OR, 3.4; 95% CI, 1.7-6.9). One of 590 children (0.2%; 95% CI, 0-0.5%) without predictors had pelvic fractures versus 86 (16.2%) of 531 in those with one or more predictors (OR, 119; 95% CI, 16.6-833). One of 87 children with pelvic fractures had no predictors (1.1%; 95% CI, 0-3%). When assuming a 100% radiography rate, this tool saves 53% pelvic radiographs.

Conclusion: Children with multiple blunt trauma without pain/abnormal examination result of the pelvis/hip, femur deformity, hematuria, abdominal pain/tenderness, GCS score of 13 or lower, or hemodynamic instability constitute a low-risk population for pelvic fracture, with less than 0.5% risk rate. This population does not require routine pelvic imaging.

Level of evidence: Therapeutic study, level IV.

MeSH terms

  • Adolescent
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Fractures, Bone / diagnostic imaging*
  • Glasgow Coma Scale
  • Humans
  • Injury Severity Score
  • Logistic Models
  • Male
  • Multiple Trauma / diagnostic imaging*
  • Multiple Trauma / surgery
  • Multivariate Analysis
  • Patient Selection
  • Pediatrics
  • Pelvic Bones / diagnostic imaging
  • Pelvic Bones / injuries*
  • Pelvic Pain / diagnostic imaging
  • Pelvic Pain / etiology
  • Registries*
  • Retrospective Studies
  • Risk Assessment
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / methods*
  • Trauma Centers
  • Treatment Outcome
  • Wounds, Nonpenetrating / diagnostic imaging*
  • Wounds, Nonpenetrating / surgery