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

3 Citations (Scopus)

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
Externally publishedYes

Fingerprint

Confidence Intervals
Pediatrics
Odds Ratio
Wounds and Injuries
Glasgow Coma Scale
Hematuria
Pelvis
Hip
Hemodynamics
Pain
Femur
Abdominal Pain
Multiple Trauma
Thigh
Radiography
Population
Registries
Hospital Emergency Service
Logistic Models
Tomography

Keywords

  • pediatrics
  • Pelvic fracture
  • pelvic radiograph
  • predictors

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

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

Which pediatric blunt trauma patients do not require pelvic imaging? / Haasz, Maya; Simone, Laura A.; Wales, Paul W.; Stimec, Jennifer; Stephens, Derek; Beno, Suzanne; Schuh, Suzanne.

In: Journal of Trauma and Acute Care Surgery, Vol. 79, No. 5, 01.11.2015, p. 828-832.

Research output: Contribution to journalArticle

Haasz, M, Simone, LA, Wales, PW, 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, vol. 79, no. 5, pp. 828-832. https://doi.org/10.1097/TA.0000000000000848
Haasz, Maya ; Simone, Laura A. ; Wales, Paul W. ; Stimec, Jennifer ; Stephens, Derek ; Beno, Suzanne ; Schuh, Suzanne. / Which pediatric blunt trauma patients do not require pelvic imaging?. In: Journal of Trauma and Acute Care Surgery. 2015 ; Vol. 79, No. 5. pp. 828-832.
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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.",
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AU - Beno, Suzanne

AU - Schuh, Suzanne

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N2 - 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.

AB - 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.

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