Blunt trauma and the role of routine pelvic radiographs

We evaluated clinical factors that are predictive of pelvic X-ray findings. We sought to identify whether routine pelvic films are necessary in blunt trauma and addressed whether removal of these films would minimize cost. We performed a retrospective chart review of Ill patients without pelvic frac tures and 108 with pelvic fractures seen at our Level 1 trauma center betwe en August 1998 and September 1999. We evaluated initial hemodynamics, physi cal examination findings, laboratory data, and hospital charges. Patients w ith fractures had higher Injury Severity Scores (P<0.001), a higher number of associated injuries (P<0.001), and lower blood pressures (P<0.001). The back and pelvic examinations were significantly associated with X-ray resul ts (P<0.001), and the potential savings with selective radiography was $168 ,300.00 per year. We believe that clinical factors identified in our study predict the need for pelvic X-ray. Because removal of these films would min imize cost we recommend the elimination of routine pelvic films for the awa ke and alert blunt trauma patient.