Sensitivity of plain pelvis radiography in children with blunt torso trauma

Maria Y. Kwok, Ken Yen, Shireen Atabaki, Kathleen Adelgais, Madelyn Garcia, Kimberly Quayle, Joshua Kooistra, Bema K. Bonsu, Kent Page, Dominic Borgialli, Nathan Kuppermann, James F. Holmes

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Study objective Plain anteroposterior pelvic radiographs are commonly used to screen children for pelvic fractures or dislocations after blunt torso trauma. The test sensitivity and utility, however, are unclear. We assessed the sensitivity of anteroposterior pelvic radiographs for identifying children with pelvic fractures or dislocations after blunt torso trauma. We hypothesized that anteroposterior pelvic radiographs fail to identify all children with pelvic fractures or dislocations, including patients undergoing operative intervention and those with hypotension.

Methods We conducted a prospective multicenter observational study of children (<18 years) with blunt torso trauma in the Pediatric Emergency Care Applied Research Network. We compared plain anteroposterior pelvic radiographs to the final diagnosis of pelvic fractures or dislocations as documented by the orthopedic faculty physician before emergency department (ED)/hospital discharge. We described the data with descriptive statistics, including 95% confidence intervals (CIs).

Results Of 12,044 patients enrolled in the parent study, 451 (3.7%; 95% CI 3.4% to 4.1%) had pelvic fractures or dislocations. Of these patients, 65 (14%; 95% CI 11% to 18%) underwent operative intervention and 21 (4.7%; 95% CI 2.9% to 7.0%) had age-adjusted hypotension on initial presentation. In the ED, 382 of the 451 patients underwent plain anteroposterior pelvic radiographs, with a sensitivity of 297 of 382 (78%; 95% CI 73% to 82%) for patients with pelvic fractures or dislocations, 55 of 60 (92%; 95% CI 82% to 97%) for patients undergoing operative intervention, and 14 of 17 (82%; 95% CI 57% to 96%) for patients with hypotension.

Conclusion Plain anteroposterior pelvic radiographs have a limited sensitivity for identifying children with pelvic fractures or dislocations after blunt trauma, including patients undergoing operative intervention and those with hypotension.

Original languageEnglish (US)
Pages (from-to)63-71
Number of pages9
JournalAnnals of Emergency Medicine
Volume65
Issue number1
DOIs
StatePublished - Jan 1 2015

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Torso
Pelvis
Radiography
Confidence Intervals
Wounds and Injuries
Hypotension
Hospital Emergency Service
Emergency Medical Services
Fracture Dislocation
Multicenter Studies
Observational Studies
Orthopedics
Pediatrics
Physicians

ASJC Scopus subject areas

  • Emergency Medicine
  • Medicine(all)

Cite this

Kwok, M. Y., Yen, K., Atabaki, S., Adelgais, K., Garcia, M., Quayle, K., ... Holmes, J. F. (2015). Sensitivity of plain pelvis radiography in children with blunt torso trauma. Annals of Emergency Medicine, 65(1), 63-71. https://doi.org/10.1016/j.annemergmed.2014.06.017

Sensitivity of plain pelvis radiography in children with blunt torso trauma. / Kwok, Maria Y.; Yen, Ken; Atabaki, Shireen; Adelgais, Kathleen; Garcia, Madelyn; Quayle, Kimberly; Kooistra, Joshua; Bonsu, Bema K.; Page, Kent; Borgialli, Dominic; Kuppermann, Nathan; Holmes, James F.

In: Annals of Emergency Medicine, Vol. 65, No. 1, 01.01.2015, p. 63-71.

Research output: Contribution to journalArticle

Kwok, MY, Yen, K, Atabaki, S, Adelgais, K, Garcia, M, Quayle, K, Kooistra, J, Bonsu, BK, Page, K, Borgialli, D, Kuppermann, N & Holmes, JF 2015, 'Sensitivity of plain pelvis radiography in children with blunt torso trauma', Annals of Emergency Medicine, vol. 65, no. 1, pp. 63-71. https://doi.org/10.1016/j.annemergmed.2014.06.017
Kwok, Maria Y. ; Yen, Ken ; Atabaki, Shireen ; Adelgais, Kathleen ; Garcia, Madelyn ; Quayle, Kimberly ; Kooistra, Joshua ; Bonsu, Bema K. ; Page, Kent ; Borgialli, Dominic ; Kuppermann, Nathan ; Holmes, James F. / Sensitivity of plain pelvis radiography in children with blunt torso trauma. In: Annals of Emergency Medicine. 2015 ; Vol. 65, No. 1. pp. 63-71.
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title = "Sensitivity of plain pelvis radiography in children with blunt torso trauma",
abstract = "Study objective Plain anteroposterior pelvic radiographs are commonly used to screen children for pelvic fractures or dislocations after blunt torso trauma. The test sensitivity and utility, however, are unclear. We assessed the sensitivity of anteroposterior pelvic radiographs for identifying children with pelvic fractures or dislocations after blunt torso trauma. We hypothesized that anteroposterior pelvic radiographs fail to identify all children with pelvic fractures or dislocations, including patients undergoing operative intervention and those with hypotension.Methods We conducted a prospective multicenter observational study of children (<18 years) with blunt torso trauma in the Pediatric Emergency Care Applied Research Network. We compared plain anteroposterior pelvic radiographs to the final diagnosis of pelvic fractures or dislocations as documented by the orthopedic faculty physician before emergency department (ED)/hospital discharge. We described the data with descriptive statistics, including 95{\%} confidence intervals (CIs).Results Of 12,044 patients enrolled in the parent study, 451 (3.7{\%}; 95{\%} CI 3.4{\%} to 4.1{\%}) had pelvic fractures or dislocations. Of these patients, 65 (14{\%}; 95{\%} CI 11{\%} to 18{\%}) underwent operative intervention and 21 (4.7{\%}; 95{\%} CI 2.9{\%} to 7.0{\%}) had age-adjusted hypotension on initial presentation. In the ED, 382 of the 451 patients underwent plain anteroposterior pelvic radiographs, with a sensitivity of 297 of 382 (78{\%}; 95{\%} CI 73{\%} to 82{\%}) for patients with pelvic fractures or dislocations, 55 of 60 (92{\%}; 95{\%} CI 82{\%} to 97{\%}) for patients undergoing operative intervention, and 14 of 17 (82{\%}; 95{\%} CI 57{\%} to 96{\%}) for patients with hypotension.Conclusion Plain anteroposterior pelvic radiographs have a limited sensitivity for identifying children with pelvic fractures or dislocations after blunt trauma, including patients undergoing operative intervention and those with hypotension.",
author = "Kwok, {Maria Y.} and Ken Yen and Shireen Atabaki and Kathleen Adelgais and Madelyn Garcia and Kimberly Quayle and Joshua Kooistra and Bonsu, {Bema K.} and Kent Page and Dominic Borgialli and Nathan Kuppermann and Holmes, {James F.}",
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AU - Kwok, Maria Y.

AU - Yen, Ken

AU - Atabaki, Shireen

AU - Adelgais, Kathleen

AU - Garcia, Madelyn

AU - Quayle, Kimberly

AU - Kooistra, Joshua

AU - Bonsu, Bema K.

AU - Page, Kent

AU - Borgialli, Dominic

AU - Kuppermann, Nathan

AU - Holmes, James F.

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N2 - Study objective Plain anteroposterior pelvic radiographs are commonly used to screen children for pelvic fractures or dislocations after blunt torso trauma. The test sensitivity and utility, however, are unclear. We assessed the sensitivity of anteroposterior pelvic radiographs for identifying children with pelvic fractures or dislocations after blunt torso trauma. We hypothesized that anteroposterior pelvic radiographs fail to identify all children with pelvic fractures or dislocations, including patients undergoing operative intervention and those with hypotension.Methods We conducted a prospective multicenter observational study of children (<18 years) with blunt torso trauma in the Pediatric Emergency Care Applied Research Network. We compared plain anteroposterior pelvic radiographs to the final diagnosis of pelvic fractures or dislocations as documented by the orthopedic faculty physician before emergency department (ED)/hospital discharge. We described the data with descriptive statistics, including 95% confidence intervals (CIs).Results Of 12,044 patients enrolled in the parent study, 451 (3.7%; 95% CI 3.4% to 4.1%) had pelvic fractures or dislocations. Of these patients, 65 (14%; 95% CI 11% to 18%) underwent operative intervention and 21 (4.7%; 95% CI 2.9% to 7.0%) had age-adjusted hypotension on initial presentation. In the ED, 382 of the 451 patients underwent plain anteroposterior pelvic radiographs, with a sensitivity of 297 of 382 (78%; 95% CI 73% to 82%) for patients with pelvic fractures or dislocations, 55 of 60 (92%; 95% CI 82% to 97%) for patients undergoing operative intervention, and 14 of 17 (82%; 95% CI 57% to 96%) for patients with hypotension.Conclusion Plain anteroposterior pelvic radiographs have a limited sensitivity for identifying children with pelvic fractures or dislocations after blunt trauma, including patients undergoing operative intervention and those with hypotension.

AB - Study objective Plain anteroposterior pelvic radiographs are commonly used to screen children for pelvic fractures or dislocations after blunt torso trauma. The test sensitivity and utility, however, are unclear. We assessed the sensitivity of anteroposterior pelvic radiographs for identifying children with pelvic fractures or dislocations after blunt torso trauma. We hypothesized that anteroposterior pelvic radiographs fail to identify all children with pelvic fractures or dislocations, including patients undergoing operative intervention and those with hypotension.Methods We conducted a prospective multicenter observational study of children (<18 years) with blunt torso trauma in the Pediatric Emergency Care Applied Research Network. We compared plain anteroposterior pelvic radiographs to the final diagnosis of pelvic fractures or dislocations as documented by the orthopedic faculty physician before emergency department (ED)/hospital discharge. We described the data with descriptive statistics, including 95% confidence intervals (CIs).Results Of 12,044 patients enrolled in the parent study, 451 (3.7%; 95% CI 3.4% to 4.1%) had pelvic fractures or dislocations. Of these patients, 65 (14%; 95% CI 11% to 18%) underwent operative intervention and 21 (4.7%; 95% CI 2.9% to 7.0%) had age-adjusted hypotension on initial presentation. In the ED, 382 of the 451 patients underwent plain anteroposterior pelvic radiographs, with a sensitivity of 297 of 382 (78%; 95% CI 73% to 82%) for patients with pelvic fractures or dislocations, 55 of 60 (92%; 95% CI 82% to 97%) for patients undergoing operative intervention, and 14 of 17 (82%; 95% CI 57% to 96%) for patients with hypotension.Conclusion Plain anteroposterior pelvic radiographs have a limited sensitivity for identifying children with pelvic fractures or dislocations after blunt trauma, including patients undergoing operative intervention and those with hypotension.

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