Abstract
Objective: Pelvic x-ray is frequently used as a screening tool during initial assessment of injured patients. However routine use in the awake and alert blunt trauma patient may be questioned due to low yield. We propose a clinical tool that may avoid unnecessary imaging by examining whether the ability to straight leg raise, without pain, can rule out pelvic injury. Methods: We conducted a prospective cohort study with the exposure variables of ability to straight leg raise and presence of pain on doing so, and presence of pelvic fracture on x-ray as the primary outcome variable. Results: Of the 328 participants, 35 had pelvic fractures, and of these 32 were either unable to straight leg raise, or had pain on doing so, with a sensitivity of 91.43% (95% CI: 76.94–98.2%) and a negative predictive value of 98.57% (95% CI: 95.88–99.70%). The 3 participants with a pelvic fracture who could straight leg raise with no pain, all had a GCS of less than 15, and therefore, among the sub-group of patients with GCS15, a 100% sensitivity and 100% negative predictive value for straight leg raise with no pain to rule out pelvic fracture was demonstrated. Conclusion: Among awake, alert patients, painless straight leg raise can exclude pelvic fractures and be incorporated into initial examination during reception and resuscitation of injured patients.
Original language | English |
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Pages (from-to) | 279-283 |
Number of pages | 5 |
Journal | Injury |
Volume | 49 |
Issue number | 2 |
DOIs | |
Publication status | Published - 1 Feb 2018 |
Keywords
- Clinical Decision-making
- Computer tomography
- Diagnostic techniques & procedures
- Fractures
- Leg
- Multiple trauma
- Pelvic bones
- Pelvis
- Physical examination
- Radiography
- Shock
- Traumatic
- Whole body imaging