The cost-effectiveness of routine pelvic radiography in the evaluation of blunt trauma patients

Objective. To determine the cost-effectiveness of routine protocol-driven p elvic radiography in the evaluation of blunt trauma patients. Design and patients. A retrospective review was performed on 319 blunt trau ma patients who underwent protocol-driven pelvic radiography to record the frequency of pelvic fracture. Medical records of the patients in whom fract ures were identified radiographically were then examined to determine the c linical suspicion of injury prior to radiography. Using Medicare reimbursem ent data, the cost-effectiveness of routine pelvic radiography was calculat ed in terms cost per pelvic radiograph with evidence of fracture. These val ues were then compared with literature values of other screening studies, n amely mammography and colonoscopy. Results. Thirty-eight of 319 patients (11.9%) were found to have fractures identified on routine pelvic radiography. Using the 1997 Medicare reimburse ment charge of $27.79 for a single anteroposterior radiograph of the pelvis , the total cost of performing these 319 trauma protocol-driven studies was calculated as $8865.01. The cost per protocol-driven pelvic radiograph wit h evidence of pelvic fracture was subsequently determined to be $233.29. On ly 18 (47.4%) of these 38 patients were suspected to have pelvic fracture o n the basis of the clinical findings alone. Conclusions. Trauma protocol-driven pelvic radiography is a necessary and c ost-effective means of identifying acute pelvic injury in all trauma patien ts regardless of clinical presentation.