TITLE

Pelvic radiography in ATLS algorithms: A diminishing role?

AUTHOR(S)
Hilty, Matthias P.; Behrendt, Isabelle; Benneker, Lorin M.; Martinolli, Luca; Stoupis, Christoforos; Buggy, Donald J.; Zimmermann, Heinz; Exadaktylos, Aristomenis K.
PUB. DATE
January 2008
SOURCE
World Journal of Emergency Surgery;2008, Vol. 3, Special section p1
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Pelvic x-ray is a routine part of the primary survey of polytraumatized patients according to Advanced Trauma Life Support (ATLS) guidelines. However, pelvic CT is the gold standard imaging technique in the diagnosis of pelvic fractures. This study was conducted to confirm the safety of a modified ATLS algorithm omitting pelvic x-ray in hemodynamically stable polytraumatized patients with clinically stable pelvis in favour of later pelvic examination by CT scan. Methods: We conducted a retrospective analysis of all polytraumatized patients in our emergency room between 01.07.2004 and 31.01.2006. Inclusion criteria were blunt abdominal trauma, initial hemodynamic stability and a stable pelvis on clinical examination. We excluded patients requiring immediate intervention because of hemodynamic instability. Results: We reviewed the records of n = 452 polytraumatized patients, of which n = 91 fulfilled inclusion criteria (56% male, mean age = 45 years). The mechanism of trauma included 43% road traffic accidents, 47% falls. In 68/91 (75%) patients, both a pelvic x-ray and a CT examination were performed; the remainder had only pelvic CT. In 6/68 (9%) patients, pelvic fracture was diagnosed by pelvic x-ray. None of these 6 patients was found having a false positive pelvic x-ray, i.e. there was no fracture on pelvic CT scan. In 3/68 (4%) cases a fracture was missed in the pelvic x-ray, but confirmed on CT (false negative on x-ray). None of the diagnosed fractures needed an immediate therapeutic intervention. 5 (56%) were classified type A fractures, and another 4 (44%) B 2.1 in computed tomography (AO classification). One A 2.1 fracture was found in a clinically stable patient who only received CT scan (1/23). Conclusion: While pelvic x-ray is an integral part of ATLS assessment, this retrospective study suggests that in hemodynamically stable patients with clinically stable pevis, its sensitivity is only 67% and it may safely be omitted in favor of a pelvic CT examination if such is planned in adjunct assessment and available. The results support the safety and utility of our modified ATLS algorithm. A randomized controlled trial using the algorithm can safely be conducted to confirm the results.]
ACCESSION #
35707322

 

Related Articles

  • Unified wavelet and gaussian filtering for segmentation of CT images; application in segmentation of bone in pelvic CT images. Vasilache, Simina; Ward, Kevin; Cockrell, Charles; Ha, Jonathan; Najarian, Kayvan // BMC Medical Informatics & Decision Making;2009 Supplement 1, Vol. 9, Special section p1 

    Background: The analysis of pelvic CT scans is a crucial step for detecting and assessing the severity of Traumatic Pelvic Injuries. Automating the processing of pelvic CT scans could impact decision accuracy, decrease the time for decision making, and reduce health care cost. This paper...

  • The incidence and the risk factors of venous thromboembolism in Korean patients with pelvic or acetabular fractures. Kim, Joon-Woo; Oh, Chang-Wug; Oh, Jong-Keon; Baek, Seung-Gil; Lee, Byoung-Joo; Hong, Han-Pyo; Min, Woo-Kie // Journal of Orthopaedic Science;May2014, Vol. 19 Issue 3, p471 

    Background: Pelvic ring and acetabular fractures are the results of high energy trauma, but there is a paucity of information available regarding the incidence and risk factors of venous thromboembolism (VTE) after these injuries in Asians. This study was undertaken to evaluate the incidence of...

  • Pelvic X-ray Caution.  // ASRT Scanner;Oct/Nov2014, Vol. 47 Issue 1, p11 

    The article offers information on the study published in the periodical "Annals of Emergency Medicine" which shows that children suffering from blunt torso trauma do not need a pelvic x-ray if an abdominal/pelvic computed tomography (CT) is being planned.

  • Fractures Around the Hip in Athletes. O'hEireamhoin, Sven; McCarthy, Tom // Open Sports Medicine Journal;2010 Special Issue, p58 

    A wide spectrum of bony injury around the hip and pelvis may occur in athletes. These injuries vary from subtle avulsions that may require appropriate diagnosis and conservative management only to joint threatening injuries requiring emergent orthopaedic treatment. This review attempts to...

  • CT scanning for diagnosing blunt ureteral and ureteropelvic junction injuries. Ortega, Sarah J.; Netto, Fernado S.; Hamilton, Paul; Chu, Peter; Tien, Homer C. // BMC Urology;2008, Vol. 8, Special section p1 

    Background: Blunt ureteral and ureteropelvic (UPJ) injuries are extremely rare and very difficult to diagnose. Many of these injuries are missed by the initial trauma evaluation. Methods: Trauma registry data was used to identify all blunt trauma patients with ureteral or UPJ injuries, from 1...

  • Differentiation between malignant and benign pathologic fractures with F-18-fluoro-2-deoxy-D -glucose positron emission tomography/computed tomography. D.-S. Shin; O.-J. Shon; S.-J. Byun; J.-H. Choi; K.-A. Chun; I.-H. Cho // Skeletal Radiology;May2008, Vol. 37 Issue 5, p415 

    Abstract Objective  To evaluate the efficacy of F-18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG PET/CT) in differentiating malignant from benign pathologic fractures. Materials and methods  F-18 FDG PET/CT was performed on 34...

  • Analysis of acetabular version in the native hip: comparison between 2D axial CT and 3D CT measurements. Dandachli, Wael; Islam, Saif Ul; Tippett, Richard; Hall-Craggs, Margaret A.; Witt, Johan D.; Ul Islam, Saif // Skeletal Radiology;Jul2011, Vol. 40 Issue 7, p877 

    Objective: To compare two-dimensional (2D) axial with three-dimensional (3D) computerized tomography (CT) measurements of acetabular version in native hips.Materials and Methods: CT scans of 34 hips in 17 consecutive patients being investigated for femoroacetabular...

  • A treatment protocol for abdomino-pelvic injuries. Alberto Nicodemo; Daniela Decaroli; Jacopo Pallavicini; Roberto Sivieri; Alessandro Aprato; Alessandro Massè // Journal of Orthopaedics & Traumatology;Jun2008, Vol. 9 Issue 2, p89 

    Abstract Background  Abdomino-pelvic injuries often present a challenge for the emergency department. Although literature reports several protocols on the treatment of abdomino-pelvic injuries aiming at defining the most advisable treatment line, optimal treatment is still controversial....

  • Technical and clinical outcome of percutaneous CT fluoroscopy-guided screw placement in unstable injuries of the posterior pelvic ring. Strobl, Frederik; Haeussler, Sophia; Paprottka, Philipp; Hoffmann, Ralf-Thorsten; Pieske, Oliver; Reiser, Maximilian; Trumm, Christoph // Skeletal Radiology;Aug2014, Vol. 43 Issue 8, p1093 

    Purpose: To evaluate technical success, complications, and effective dose in patients undergoing CT fluoroscopy-guided iliosacral screw placement for the fixation of unstable posterior pelvic ring injuries. Materials and methods: Our retrospective analysis includes all consecutive patients with...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics