Determination of Clinical Signs and Symptoms Predicting No Pelvic Fracture in Patients with Multiple Trauma

Majidinejad, Saeed; Heidari, Farhad; Kang, Hosein Kafi; Golshani, Keyhan

Determination of Clinical Signs and Symptoms Predicting No Pelvic Fracture in Patients with Multiple Trauma

Document Type : Original Article

Authors

Department of Emergency Medicine, Emergency Medicine Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Pelvic fracture (PF) is the second-most prevalent cause of mortality after brain trauma among multiple trauma patients. Our aim was to examine the reliability of suggestive criteria for having no PF (NPF) according to the common reported clinical signs and symptoms (CSSs). Materials and Methods: In the current prospective study, 3527 patients with multiple trauma were recruited according to the guideline of emergency medicine. Information on age, gender, pelvic pain or tenderness, sacrum and coccyx pain or tenderness, the ability to active straight leg raising (SLR), and distracting injury was collected, and PF was examined by either X-ray or computed tomography (CT) scan. Results: The CSS sensitivity of NPF was 39.75% and the specificity was 100%. The no distracting injury was not significantly different according to the CSS criteria and results of X-ray and CT scan (P = 0.269); however, the difference of other criteria was significant (P < 0.0001). No pelvic pain or tenderness and the ability to active SLR considerably affected the prediction of NPF (P < 0.0001). No distracting injury can be omitted from the criteria without any effect on specificity, but with increased sensitivity (60.8% with three criteria vs. 39.7% with four criteria). Conclusion: According to our results, it can be said that due to the high predictive value of our suggestive criteria, it could be applicable as the important criteria for defecting NPF among patients with the possibility of PF. This approach can reduce the necessity of imaging in these patients which helps to reduce the health cost and hazards of X-ray used for imaging and exhaustion of medical devices.

Keywords

References

1.	Townsend CM Jr., Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery E-book. Elsevier Health Sciences; 2016.
2.	Scalea TM, Burgess AR. Pelvic fractures. Trauma. 4^th ed. New York: McGraw-Hill; 2000. p. 807-37.
3.	Flint L, Cryer HG. Pelvic fracture: The last 50 years. J Trauma 2010;69:483-8.
4.	Evers BM, Cryer HM, Miller FB. Pelvic fracture hemorrhage. Priorities in management. Arch Surg 1989;124:422-4.
5.	Sauerland S, Bouillon B, Rixen D, Raum MR, Koy T, Neugebauer EA, et al. The reliability of clinical examination in detecting pelvic fractures in blunt trauma patients: A meta-analysis. Arch Orthop Trauma Surg 2004;124:123-8.
6.	Marx J, Walls R, Hockberger R. Rosen's Emergency Medicine-Concepts and Clinical Practice E-book. Elsevier Health Sciences; 2013.
7.	Yugueros P, Sarmiento JM, Garcia AF, Ferrada R. Unnecessary use of pelvic x-ray in blunt trauma. J Trauma 1995;39:722-5.
8.	Yoshihara H, Yoneoka D. Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: Trends and in-hospital mortality. J Trauma Acute Care Surg 2014;76:380-5.
9.	Al Balushi AA, Malik KA. Role of pelvic X-ray in blunt trauma patients – A university hospital experience in Oman. J Pak Med Assoc 2015;65:910-2.
10.	Wang H, Phillips JL, Robinson RD, Duane TM, Buca S, Campbell-Furtick MB, et al. Predictors of mortality among initially stable adult pelvic trauma patients in the US: Data analysis from the national trauma data bank. Injury 2015;46:2113-7.
11.	Giannoudis PV, Grotz MR, Tzioupis C, Dinopoulos H, Wells GE, Bouamra O, et al. Prevalence of pelvic fractures, associated injuries, and mortality: The United Kingdom perspective. J Trauma 2007;63:875-83.
12.	Duane TM, Wilson SP, Mayglothling J, Wolfe LG, Aboutanos MB, Whelan JF, et al. Canadian cervical spine rule compared with computed tomography: A prospective analysis. J Trauma 2011;71:352-5.
13.	Junkins EP, Furnival RA, Bolte RG. The clinical presentation of pediatric pelvic fractures. Pediatr Emerg Care 2001;17:15-8.
14.	Breuil V, Roux CH, Carle GF. Pelvic fractures: Epidemiology, consequences, and medical management. Curr Opin Rheumatol 2016;28:442-7.
15.	Coppola PT, Coppola M. Emergency department evaluation and treatment of pelvic fractures. Emerg Med Clin North Am 2000;18:1-27, v.

Advanced Biomedical Research