The Diminishing Role of Pelvic Stability Evaluation in the Era of Computed Tomographic Scanning.

ABSTRACT

Pelvic fractures can result in life-threatening hemorrhages or other associated injuries. Therefore, computed tomography (CT) scanning plays a key role in the management of pelvic fracture patients. However, CT scanning is utilized as an adjunct in secondary survey according to traditional Advanced Trauma Life Support (ATLS) guidelines, whereas pelvic x-ray is used as a primary tool to evaluate pelvic stability and the necessity of further CT scanning. In the current study, we attempted to evaluate the role of CT scanning in the era of advanced technology. The significance of pelvic stability was also analyzed. From January 2012 to December 2014, the trauma registry and medical records of pelvic fracture patients were retrospectively reviewed. A 64-slice multidetector CT scanner was used in our emergency department as a standard diagnostic tool for evaluating trauma patients. Pelvic x-ray was used as a primary tool for screening pelvic fractures, and pelvic stability was evaluated accordingly. CT scans were performed in patients with unstable pelvic fractures, suspected associated intra-abdominal injuries (IAIs), or other conditions based on the physicians' clinical judgment. The clinical features of patients with stable and unstable pelvic fractures were compared. The patients with stable pelvic fractures were analyzed to determine the characteristics associated with retroperitoneal hemorrhage (RH) or IAIs. Patients with stable pelvic fractures were also compared based on whether they underwent a CT scan. A total of 716 patients were enrolled in this study. There were 533 (74.4%) patients with stable pelvic fractures. Of these patients, there were 66 (12.4%) and 50 (9.4%) patients with associated RH and IAI, respectively. There were no significant differences between the patients with associated RH based on their primary evaluation (vital signs, volume of blood transfusion, and hemoglobin level). Similarly, the demographics and the primary evaluation results (symptoms, coma scale, and white blood cell counts) of the patients with associated IAIs were also not significantly different from the patients without associated IAIs. Furthermore, the time to definitive hemostasis (surgery or angioembolization) was not significantly different between the unstable patients who underwent a CT scan or those who did not.In the management of pelvic fracture patients, the role of pelvic stability is not significant in the evaluation of associated RH or IAI. Routine CT scanning is suggested for pelvic fracture patients because of the rapid scanning time and sufficient information produced.