Blunt trauma and the role of routine pelvic radiographs: a prospective analysis.

Background: We hypothesized that clinical factors accurately identify those trauma patients at high risk for pelvic fractures making routine films unnecessary.
Methods: Blunt trauma patients were prospectively analyzed both with and without a clinical protocol. The protocol group had pelvic films obtained only if they had a Glasgow Coma Scale score < 13 or had signs and symptoms of pelvic or back injury.
Results: The protocol patients with fractures (n = 45) had a higher Injury Severity Score (p = 0.001) and lower systolic blood pressure (p = 0.04) than those without fractures (n = 475). All 45 patients with pelvic fractures were identified by history and physical examination (p = 0.001). The clinical assessment resulted in a sensitivity and a negative predictive value of 100%. A total of 273 films were eliminated, resulting in a charge savings of $51,051. A comparison between the protocol and nonprotocol groups showed the nonprotocol patients with pelvic fractures to have a higher Injury Severity Score (p < 0.002). All of these patients' pelvic fractures were identified by clinical evaluation (67 of 67).
Conclusion: In the awake and alert patient, the need for a pelvic radiograph was readily identified by clinical examination. Because elimination of this film would result in financial savings, its routine use should be removed from standard trauma protocols in the minimally injured patient and limited to severely injured patients as recommended by the Advanced Trauma Life Support protocol.