Optimizing Pelvic X-Ray indication in blunt trauma patients using clinical criteria

ABSTRACT Objective: to identify a subgroup of blunt trauma patients with very low chance of sustaining pelvic fractures based on clinical criteria. Methods: retrospective analysis of the trauma registry data, collected in a period of 24 months. We selected adult blunt trauma patients who had a PXR on admission. The frequency of pelvic fractures was calculated for the following groups: Normal neurological examination at admission (NNE), hemodynamical stability (HS), normal pelvic examination at admission (NPE), less than 60 years old (ID<60) and absence of distracting injuries (ADI). Logistic regression analysis was carried out in order to create a probability model of negative PXR. Results: an abnormal PXR was identified in 101 (3.3%) out of the 3,055 patients who had undergone a PXR at admission. Out of these, 1,863 sustained a NNE, with 38 positive CXRs (2.0%) in this group. Considering only the 1,535 patients with NNE and HS, we found 28 positive PXRs (1.8%). Out of these, 1,506 have NPE, with 21 abnormal PXRs (1.4%). Of these, 1,202 were younger than 60 y, with 11 positive PXRs (0.9%). By adding all these criteria to the ADI, we found 2 abnormal PXRs in 502 (0.4%) cases. The probability model including all these variables had a 0,89 area under the ROC curve. Conclusions: by adding clinical criteria, it is possible to identify a group of trauma patients with very low chance of sustaining pelvic fractures. The necessity of PXR in these patients needs to be reassessed.

摘要
研究目的：基于临床标准，识别钝性创伤患者中发生骨盆骨折概率极低的亚组人群。
方法：对24个月内收集的创伤登记数据开展回顾性分析。纳入入院时接受骨盆X线摄影（PXR）检查的成年钝性创伤患者，计算以下分组的骨盆骨折发生率：入院时神经系统检查正常（NNE）、血流动力学稳定（HS）、入院时骨盆检查正常（NPE）、年龄＜60岁（ID<60）以及无分散性损伤（ADI）。采用logistic回归分析构建PXR阴性的概率预测模型。
结果：在3055例入院时接受PXR检查的患者中，101例（3.3%）PXR结果异常。其中1863例患者入院时神经系统检查正常（NNE），该组中38例胸部X线摄影（CXR）结果异常，占比2.0%。仅纳入同时满足NNE与血流动力学稳定（HS）的1535例患者，其中28例PXR结果异常（1.8%）。该亚组中1506例入院时骨盆检查正常（NPE），其中21例PXR结果异常（1.4%）。其中1202例年龄＜60岁，11例PXR结果异常（0.9%）。将所有上述标准结合无分散性损伤（ADI）后，在502例患者中仅发现2例PXR结果异常（0.4%）。包含所有上述变量的概率模型的受试者工作特征（ROC）曲线下面积为0.89。
结论：结合多项临床标准，可识别出骨盆骨折发生概率极低的创伤患者亚组，此类患者行PXR检查的必要性需重新评估。