The trauma pelvic X-ray: Not all pelvic fractures are created equally

• Published in: The American journal of surgery Vol. 224; no. 1; pp. 489 - 493
• Main Authors: Benjamin, Elizabeth R., Jakob, Dominik A., Myers, Lee, Liasidis, Panagiotis, Lewis, Meghan, Fu, Yong, Demetriades, Demetrios
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2022; Elsevier Limited
• Subjects: Accuracy; Acetabulum; Computed tomography; CT-scan; Data collection; Emergency medical care; Emergency medical services; Fractures; Hemodynamics; Injuries; Medical imaging; Patients; Pelvic X-ray; Radiology; Sacrum; Sensitivity; Specificity; Trauma; X-rays; CT-scan; Accuracy; Sensitivity; Specificity; Pelvic X-ray
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2022.01.009

The primary aim of this study was to evaluate the role of the initial pelvic X-ray in identifying significant pelvic fractures, which could result in changes in the management of the patient. Patients admitted to a level I trauma center (2010–2019) with a severe blunt pelvic fracture (AIS ≥3) were identified. Included in the analysis were patients who underwent emergency department pelvic X-ray followed by CT scan. A control group of patients without pelvic fractures was also included in the study. All investigations were reviewed by a blinded attending trauma radiologist. Pelvic X-ray findings and CT scan reports were compared according to the specific pelvic fracture location, and severity. Overall, pelvic X-ray was diagnosed 252 of the 285 pelvic fractures (sensitivity 88.4%) and wrongly diagnosed a facture in 3 of 97 patients without a fracture (specificity 96.9%). In 29/184 (15.8%) of patients with pelvic fracture AIS 3, the pelvic X-ray was read as normal, missing the fracture, compared with 4/101 (4.0%) in the AIS 4/5 group (p = 0.003). Pelvic X-ray had the lowest sensitivity in ischial (10.7%), iliac (28.7%), acetabular (42.4%), and sacral fractures (49.1%) and was best for detecting symphysis diastasis (89.8%). Pelvic X-ray is useful in identifying pubic symphysis diastasis. However, it misses or underestimates a significant number of fractures. CT scan evaluation should be performed in patients with a suspicious mechanism or clinical suspicion of pelvic fracture. •Pelvic X-ray in the trauma bay is useful in identifying severe pubic symphysis diastasis.•Pelvic X-ray misses or underestimates a significant number of fractures.•A pelvic X-ray should be performed in hemodynamically unstable patients or those with concern of severe pelvic fracture patterns that will require early intervention.•Routine pelvic X-ray in hemodynamically stable patients that will proceed to CT of the pelvis, is of little or no value.