Annual Meeting ArticlesBlunt Trauma and the Role of Routine Pelvic Radiographs: A Prospective AnalysisDuane, Therèse M. MD; Tan, Bethany B. MD; Golay, David MURP; Cole, Frederic J. Jr., MD; Weireter, Leonard J. Jr., MD; Britt, L. D. MD, MPHAuthor Information From the Department of Surgery, Eastern Virginia Medical School (F.J.C., L.J.W., L.D.B.), and Decision Support and Evaluation, Office of Education (D.G.), Norfolk, Virginia, R Adams Cowley Shock Trauma Center, University of Maryland Medical School (T.M.D.), Baltimore, Maryland, and Section of Thoracic Surgery, University of Michigan (B.B.T.), Ann Arbor, Michigan. Submitted for publication January 8, 2002. Accepted for publication May 21, 2002. This work was scheduled for poster presentation at the 61st Annual Meeting of the American Association for the Surgery of Trauma, which was canceled because of the terrorist attacks of September 11, 2001. Presented at the Residents’ Trauma Paper Competition, Virginia State Committee on Trauma Meeting, October 2000, Fairfax, Virginia; Residents’ Trauma Paper Competition, Region III, Committee on Trauma Meeting, December 2000, West Virginia; American College of Surgeons, Virginia Chapter Meeting, May 2001, Fairfax, Virginia. Address for reprints: Frederic J. Cole, Jr., MD, Department of Surgery, Eastern Virginia Medical School, 825 Fairfax Avenue, Norfolk, VA 23507. The Journal of Trauma: Injury, Infection, and Critical Care: September 2002 - Volume 53 - Issue 3 - p 463-468 Buy Abstract Background We hypothesized that clinical factors accurately identify those trauma patients at high risk for pelvic fractures making routine films unnecessary. Methods Blunt trauma patients were prospectively analyzed both with and without a clinical protocol. The protocol group had pelvic films obtained only if they had a Glasgow Coma Scale score < 13 or had signs and symptoms of pelvic or back injury. Results The protocol patients with fractures (n = 45) had a higher Injury Severity Score (p = 0.001) and lower systolic blood pressure (p = 0.04) than those without fractures (n = 475). All 45 patients with pelvic fractures were identified by history and physical examination (p = 0.001). The clinical assessment resulted in a sensitivity and a negative predictive value of 100%. A total of 273 films were eliminated, resulting in a charge savings of $51,051. A comparison between the protocol and nonprotocol groups showed the nonprotocol patients with pelvic fractures to have a higher Injury Severity Score (p < 0.002). All of these patients’ pelvic fractures were identified by clinical evaluation (67 of 67). Conclusion In the awake and alert patient, the need for a pelvic radiograph was readily identified by clinical examination. Because elimination of this film would result in financial savings, its routine use should be removed from standard trauma protocols in the minimally injured patient and limited to severely injured patients as recommended by the Advanced Trauma Life Support protocol. © 2002 Lippincott Williams & Wilkins, Inc.