The value of clinical examination in diagnosing pelvic fractures in blunt trauma patients: a brief review

PURPOSE OF THE STUDY: To evaluate the value of a pelvic X-ray compared to clinical examination in diagnosing pelvic ring fractures, using computed tomography (CT) as the gold standard, in alert [Glasgow Coma Scale (GCS) ≥ 13] adult blunt trauma patients in the emergency room. METHODS: A systematic literature search was performed in PubMed and Embase. The results were screened on their titles and abstracts using in- and exclusion criteria. Subsequently, the selected articles were critically appraised for their relevance and validity. RESULTS: Two studies investigating the diagnostic value of clinical examination and pelvic X-ray compared to CT were identified. Both studies demonstrate higher negative predictive values for clinical examination [0.99 (95% confidence interval [CI] 0.98–1.0) and 1.0 (95% CI 0.99–1.0)] compared to the negative predictive values of pelvic X-ray [0.98 (95% CI 0.93–0.99) and 0.99 (95% CI 0.99–1.0)]. The positive predictive values for clinical examination were low [0.18 (95% CI 0.16–0.23) and 0.35 (95% CI 0.30–0.42)] compared to pelvic X-ray [0.97 (95% CI 0.96–0.98) and 0.97 (95% CI 0.90–0.99)]. CONCLUSIONS: In alert blunt trauma patients, pelvic X-ray only has additional diagnostic value for the detection of pelvic ring fractures if the clinical examination is positive. Pelvic X-ray should not be performed if the clinical examination is negative. In this manner, the expenditure of time, costs, and radiation are optimized.