E. G. Englert1,2, C. Buonpane1,2, G. Ares1,2,3, B. Benyamen2, C. J. Hunter1,2 1Feinberg School Of Medicine – Northwestern University,Surgery,Chicago, IL, USA 2Ann & Robert H. Lurie Children’s Hospital of Chicago,Pediatric Surgery,Chicago, IL, USA 3University Of Illinois At Chicago,General Surgery,Chicago, IL, USA
Introduction: Pelvic fractures are uncommon yet potentially serious injuries in pediatric trauma patients. The role of computed tomography (CT) scans in addition to standard pelvic radiographs (XR) in identifying and altering management of pelvic fractures is controversial. Unnecessary use of CT scan is especially undesirable in the context of minimizing pediatric radiation exposure. We hypothesized that CT scan for pelvic fractures would not significantly change patient diagnosis or management. In order to minimize utilization of CT scan, this study sought to use history and physical examination findings to identify high risk patients who would benefit from CT scan.
Methods: This study is a single institution retrospective review of patients ≤18 years old who were seen by the trauma service for blunt trauma and underwent pelvic radiograph from 2014 to 2016. Patients with pelvic XR alone were compared to those who received pelvic XR and CT scan. Primary outcome was pelvic fracture. Secondary outcomes included management, length of stay and survival.
Results: 257 patients were identified, of which 156 (60.7%) had pelvic XR alone while 47 (18.3%) received pelvic XR and CT scan. Patients that were chosen for CT scan were more likely to have pelvic tenderness (OR 2.7, 95%CI 1.03-6.94, p=0.04), injury of the spine (OR 4.9, 95%CI 1.19-20.29, p=0.03) and/or abdominal tenderness (OR 5.6, 95%CI 1.87-16.98, p=0.002).
Eighteen patients (7%) were diagnosed with pelvic fracture. Patients with pelvic fracture were 23 times more likely to have pelvic tenderness on physical examination than patients without fracture (OR 23.2, 95%CI 6.86-78.5, p<0.001). The sensitivity, specificity, positive predictive value and negative predictive value of diagnosis of pelvic fractures on pelvic XR alone was 83.3%, 100%, 100% and 98.77%, respectively. Eight of the 18 patients with fractures received both X-rays and CT. Pelvic injury findings were identical in 6 of those patients. However, in two patients, XR failed to diagnose fractures that were later seen on CT scan (fractures of the acetabulum, ilium, sacrum and sacroiliac joint disruption). The additional findings, however, did not change patient management (observation and physical therapy).
Conclusion: CT scan is more sensitive than pelvic XR in the diagnosis of a pelvic fracture; however, in our series this did not result in a change in patient management. In patients with XR and a high clinical suspicion of more extensive injuries based on pelvic tenderness and other physical examination findings, we recommend a CT scan.