Straight leg elevation to rule out pelvic injury

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Radiology

Background:

• Pelvic x-rays are standard for trauma assessment but often yield low results in alert patients.
• Routine imaging may be questioned due to low diagnostic yield in specific patient populations.

Purpose of the Study:

• To evaluate the utility of painless straight leg raise as a screening tool for pelvic injury.
• To determine if the ability to perform a straight leg raise without pain can rule out pelvic fractures.

Main Methods:

• Prospective cohort study design.
• Assessed straight leg raise ability and pain as exposure variables.
• Pelvic fracture on x-ray served as the primary outcome.

Main Results:

• In 328 participants, 35 had pelvic fractures; 32 were unable to perform a straight leg raise or experienced pain.
• Sensitivity was 91.43% and negative predictive value was 98.57% for detecting pelvic fractures.
• In patients with a Glasgow Coma Scale (GCS) of 15, painless straight leg raise demonstrated 100% sensitivity and 100% negative predictive value.

Conclusions:

• Painless straight leg raise is a reliable clinical tool to exclude pelvic fractures in awake and alert patients.
• This assessment can be integrated into the initial examination of injured patients during reception and resuscitation.
• Reduces the need for routine pelvic x-rays in select trauma cases.