Which pediatric blunt trauma patients do not require pelvic imaging?

Area of Science:

• Pediatric Emergency Medicine
• Trauma Surgery
• Radiology

Background:

• Pelvic fractures are a concern in pediatric blunt trauma.
• Developing a tool to identify low-risk children can optimize imaging practices.

Purpose of the Study:

• To create a predictive model for identifying children with blunt trauma at low risk of pelvic fracture.
• To assess the sensitivity of this low-risk model for pelvic fractures.

Main Methods:

• Retrospective analysis of a trauma registry including 1,121 children (1-17 years) with blunt trauma.
• Identified predictors of pelvic fracture using multivariable logistic regression.
• Evaluated the risk of pelvic fracture in children with and without identified predictors.

Main Results:

• 87 (7.8%) of 1,121 children sustained pelvic fractures.
• Independent predictors included pelvic/hip pain/abnormal exam, hematuria, femoral deformity, low Glasgow Coma Scale (GCS) score, and hemodynamic instability.
• Children without any predictors had a pelvic fracture risk of 0.2%, significantly lower than those with predictors (16.2%).

Conclusions:

• Children with blunt trauma lacking specific predictors (pelvic/hip pain, femur deformity, hematuria, abdominal pain, low GCS, hemodynamic instability) are at low risk (<0.5%) for pelvic fracture.
• This low-risk group may not require routine pelvic imaging, potentially reducing unnecessary radiation exposure and healthcare costs.