Which pediatric blunt trauma patients do not require pelvic imaging?

Maya Haasz, Laura A. Simone, Paul W. Wales, Jennifer Stimec, Derek Stephens, Suzanne Beno, Suzanne Schuh

Research output: Contribution to journalArticle

4 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)828-832
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume79
Issue number5
DOIs
StatePublished - Nov 1 2015

Keywords

  • Pelvic fracture
  • pediatrics
  • pelvic radiograph
  • predictors

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Which pediatric blunt trauma patients do not require pelvic imaging?'. Together they form a unique fingerprint.

  • Cite this

    Haasz, M., Simone, L. A., Wales, P. W., Stimec, J., Stephens, D., Beno, S., & Schuh, S. (2015). Which pediatric blunt trauma patients do not require pelvic imaging? Journal of Trauma and Acute Care Surgery, 79(5), 828-832. https://doi.org/10.1097/TA.0000000000000848