NEW YORK (Reuters Health) – In patients with blunt trauma who are awake and alert, clinical examination can reliably rule out significant pelvic fracture, according to a report in the February issue of the Journal of the American College of Surgeons. The sensitivity in diagnosis of surgically significant pelvic fractures is not improved by the addition of anterior-posterior (A-P) x-ray.
Dr. Richard P. Gonzalez, of the University of South Alabama Medical Center, Mobile, and colleagues prospectively studied the sensitivity of clinical examination in screening for pelvic fracture in awake and alert blunt trauma patients. They evaluated 2176 consecutive patients who presented with blunt trauma over a 32-month period. Before an A-P pelvic x-ray was performed, the clinical examination of each patient was documented.
Of the 2176 patients, 97 (4.5%) were diagnosed with pelvic fracture. Seven injuries were missed on clinical examination, for a sensitivity of 93%. "None of the seven missed injuries required surgical intervention and only two of these injured patients were placed on nonweight bearing status because of the pelvic fracture," the investigators explain.
Thirteen injuries were missed by A-P radiography, for a sensitivity of 87%. All of the missed injuries were subsequently identified by CT, according to the team.
Of 463 patients (21%) who presented with elevated blood ethanol levels, 20 (4%) were diagnosed with pelvic fractures. Nineteen of these fractures (95%) were diagnosed on clinical examination. "Elevated ethanol level is not a contraindication to use of clinical examination as a screening modality for pelvic fractures in the awake and alert blunt trauma patient," Dr. Gonzalez and colleagues note.