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Pelvic radiography is not always indicated in severe blunt trauma if the patient has no pelvic symptoms and is GCS 15

Three Part Question

In [adults who have experienced severe blunt trauma who are fully conscious and asymptomatic] is [pelvic x-ray] necessary to exclude [significant bony pelvic damage]?

Clinical Scenario

A 40 year old male is admitted into the resuscitation area of the Emergency Department following a high speed road traffic accident. He tells you he has not injured his head and has no pain in his pelvic area. He is alert orientated, he is not under the influence of any alcohol or drugs, and is neurologically intact. You cannot find any major injuries, his pulse is 94, and BP 145/90. He has no pain on flexing his pelvis. You wonder if it is necessary to perform a pelvic x-ray.

Search Strategy

Medline 1966-11/02 using the OVID interface.
({[exp pelvis OR pelvi$.ti,ab,rw,sh] AND [exp x-rays OR x-ray$.ti,ab,rw,sh OR radiograph$.ti,ab,rw,sh] AND [exp "wounds and injuries" OR injur$.ti,ab,rw,sh OR trauma$.ti,ab,rw,sh] AND blunt$.ti,ab,rw,sh} LIMIT to human and english).

Search Outcome

58 papers found

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Civil ID et al,
265 patients with possible major traumaProspective surveyFracture rates by clinical groupUnconscious (GCS<8) 19%
Obtunded (8< GCS<15) 11%
Pelvic symptoms GCS=1535%
No pelvic symptoms GCS=150%
Salvino CK et al,
810 blunt trauma patients . 12y old with GCS > 13.Prospective surveyFracture rates by clinical findings (pelvic symptoms and/or signs)Positive: 56.3%
Negative: 0.04%
Yugueros P et al,
608 haemodynamically stable adults with GCS > 10 and no spinal involvementProspective surveyFracture rates by clinical findingsPositive: 96.6%
Negative: 0.004%
Ersoy G et al,
65 conscious, non-intoxicated, orientated patientsRetrospective surveyFracture rates by clinical findingsPositive: 43.8%
Negative: 0%
Retrospective. Small numbers.
Heath FR et al,
82 adult, awake, alert blunt trauma victimsProspective surveyFracture rates by clinical findingsPositive: 38.9%
Negative: 3.13%
Small numbers.


The studies above include 1699 awake patients. Aggregated figures show that clinical symptoms and signs predict pelvic fracture with a sensitivity of 95.45% and a specificity of 95.53%. Furthermore the absence of clinical symptoms and signs has a negative predictive value of 99.6% in this group of patients.

Clinical Bottom Line

Adult trauma patients who are awake with normal sensation and who have no pelvic symptoms or signs do not need a pelvic x-ray.


  1. Civil ID, Ross SE, Botehlo G, Schwab CW. Routine pelvic radiography in severe blunt trauma: is it necessary? Ann Emerg Med 1988;17:488-490.
  2. Salvino CK, Esposito TJ, Smith D et al. Routine pelvic x-ray studies in awake blunt trauma patients: a sensible policy? J Trauma 1992;33:413-416.
  3. Yugueros P, Sarmiento JM, Garcia AF et al. Unnecessary use of pelvic x-ray in blunt trauma. J Trauma 1995;39:722-725.
  4. Ersoy G, Karcioglu O, Enginbas Y et al. Should all patients with blunt trauma undergo 'routine' pelvic X-ray? Eur J Emerg Med 1995;2:65-68.
  5. Heath FR, Blum F, Rockwell S. Physical examination as a screening test for pelvic fractures in blunt trauma patients. West Virginia Med J 1997;93:267-269.