Role of Computed Tomography in the Classification of Pediatric Pelvic Fractures-Revisited.

    loading  Checking for direct PDF access through Ovid

Abstract

OBJECTIVES

To determine the need for computerized tomography (CT) scans in the assessment of pediatric pelvic fractures.

DESIGN

Retrospective Chart Review.

SETTING

Level-1 Pediatric Trauma Center.

PATIENTS/PARTICIPANTS

Thirty pediatric trauma patients with pelvic fractures who have obtained both a radiograph and CT scan.

MAIN OUTCOME MEASUREMENTS

Fleiss Kappa coefficient to compare interreliability.

RESULTS

The average age of the patients was 7 years (range 1-13 years). Seventeen were males and 13 were females. The Torode and Zieg classification included 3 type I, 6 type II, 13 type III, and 8 type IV. The Kappa value for interobserver agreement comparing radiographs was 0.453, and for CT was 0.42. Three patients (10%) were treated with a spica cast, and none required surgery for their pelvic fracture. Four patients (11%) demonstrated liver, spleen, or kidney injuries on CT. Out of those 4, 1 had indications for laparotomy and drain placement, 1 died secondary to shock, and 2 were treated conservatively.

CONCLUSIONS

The results of this study demonstrated that plain radiographs alone can be used to classify and manage most pediatric fractures, confirming Silber previous findings. Furthermore, we recommend the specific instances of Schreck and Haasz et al in which CT scans should be used, sparing the general pediatric population unnecessary radiation. Such cases include patients with an abnormal abdominal or pelvic examination, complex fracture patterns, displacement greater than 1 cm, femur deformities, hematuria, Glasgow Coma Scale <13, hemodynamic instability, an aspartate aminotransferase > 200 U/L, an Hct < 30%, or an abnormal chest x-ray.

Related Topics

    loading  Loading Related Articles