The Agreement of Physical Examination and Plain PelvicRadiography Findings in Trauma Patients Presenting tothe Emergency Department; a Diagnostic Accuracy Study

Due to the high volume of trauma patients, the total amount of pelvic X-rays performed is very high, which both imposes a high cost on the health care system and society, and exposes patients to side effects of X-rays. Therefore, the aim of this study was to assess the accuracy of clinical pelvic examination findings in identification of trauma patients in need of a pelvic X-ray (PXR).

In this prospective cross-sectional study, all multiple-trauma patients referring to the emergency department of Ayatollah Kashani Hospital in Shahrekord during September 2020 who underwent PXR were included. Clinical examination findings were recorded for all patients and the accuracy of these findings in determination of the need for performing PXR was evaluated.

131 patients with a mean age of 34.18±22.96 years were studied (75.6% male). 124 people (94.6%) had normal PXR and 7 people (5.4%) had abnormal PXR. The two groups were in the same condition in terms of age (p = 0.993), sex (p = 0.679), weight (p = 0.953), blood pressure (p = 0.848), heart rate per minute (p = 0.907), the number of breaths per minute (p = 0.996), the level of consciousness (p = 1.00) and the mechanism of trauma (p = 0.996). Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and finally, the accuracy of clinical pelvic examination of trauma patients in determining the need for simple pelvic x-rays were 100%, 79.03%, 98.82%, 100%, 4.77, 0, and 98.87%, respectively.

According to the results of the present study, if the patient met at least one of the eight clinical criteria, the diagnosis of pelvic fracture was considered, indicating that this general criterion could easily succeed in identifying all fractures with 100% sensitivity and unnecessary PXR could easily be avoided in more than 70% of these patients.