M. Moosa1, I. Jangda1, H. Zafar1 1Aga Khan University Hospital Karachi,Department Of Surgery,Karachi, SINDH, Pakistan
Introduction: Pelvic fractures is common and can be potentially life threatening. The early diagnosis of pelvic fractures resulting from blunt abdominal trauma traditionally relies on the anterior-posterior pelvic radiograph although sometimes it may not give a definitive diagnosis of pelvic fractures. So reliability of pelvic x-ray has been questioned and ways of removing pelvic x-ray from the ATLS protocol are being observed on the basis of finding the reliability of clinical examination in finding out pelvic fractures in alert and awake, hemodynamically stable patient and also to avoid the unnecessary exposure of radiation and reduce the financial burden.
Methods: This is a cross sectional study conducted in the department of surgery, Aga Khan University Hospital, Karachi. This study included patients with blunt trauma mainly the road traffic accident victims presenting the emergency department with GCS of 15, hemodynamically stable and alert and awake. Clinical examination of pelvis of these patients were done on three different examination maneuvers and assessment of pelvic made which was then compared to routine pelvic x-ray findings.
Results:
Total of two twenty one (221) of blunt trauma patients were reviewed having mechanism of injury being road traffic accident and history of fall. Of these 221 patients thirty two (32) were not entered in the study as they had GCS of < 15, fifteen patients were not included as they have abdominal tenderness, fourty one (41) patients had associated lower limb injuries. So the final of one thirty three (133) patients were included in our study. Of these 133 patients majority of patients were male around 91.7% and 8.9% were females. Mean age of patients included in this study 37 with standard deviation of +/- 14.2. Fourteen patients were positive for pelvic fracture on clinical examination and positive on PXR categorized as true positive (TP), fourteen patients were positive for pelvic fracture on clinical exam but negative on PXR and categorized as false positive (FP), two patients were negative for pelvic fracture on clinical exam but positive on PXR categorized as false negative (FN), one hundred and three patients were negative for pelvic fracture both on clinical exam and PXR and were labelled as true negative (TN).
Sensitivity, Specificity, Positive predictive value and Negative predictive value were calculated by using two X two table. Sensitivity of clinic examination was found to be 87.5%, Specificity 88.03%, Positive Predictive Value 50% and Negative predictive value 98.09%.
Conclusion: In relation to above mention findings new protocol can be advised for alert and awake patients and pelvic x-ray can be avoided helping in reducing the financial burden to patient, reducing emergency hassle and unnecessary radiation.