Pelvic x-ray not mandatory for abdominal trauma in children, study finds

Nov 30, 2004

CHICAGO - In an age when scanning patients has become routine, new research presented at the RSNA finds that pelvic radiograph is not indicated for blunt abdominal trauma in children younger than 12 years, unless the trauma was caused by a motor vehicle crash or certain other factors pertain to the case.

Researchers from the Louisiana State University Health Sciences Center listed the other factors as hematuria, initial requirement for blood transfusion, and an abnormal physical exam.

"If the pelvic exam is normal, then there is a 97% negative predictive value for a pelvic fracture," according to Dr. Grady Yoder, who presented the paper on Wednesday. The positive predictive value for a pelvic exam was 52%, and sensitivity and specificity was 55% and 97%, respectively.

The study was done over a three-year period, and evaluated the results from 355 children between 1 and 16 years of age. Age, sex, mechansim of injury, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), presence of hematuria, and toxicology were considered for each patient.

Using multivariate analysis, the researchers found that pelvic examination and requirement for blood transfusion within 24 hours were independent predictors for pelvic fractures.

"Using univariate analysis, the following factors were significant for pelvic fractures: age greater than 12 years (p < 0.002), motor vehicle mechanism (p < 0.001), requirement for blood transfusion in the first 24 hours (p < 0.008), abnormal pelvic physical examination for iliac crest (p < 0.002), and positive toxicology screen (p < 0.002)," the researchers wrote.

A 5% level of confidence was used for the statistical tests.

By N. Shivapriya
AuntMinnie.com staff writer
December 1, 2004