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Crash site data along with pelvic x-rays may aid triage of motor vehicle crash victims with pelvic fractures

Patients who suffer pelvic fractures due to motor vehicle accidents or other traumas usually receive pelvic x-rays upon arrival at the emergency department. Direction of injury force inferred from pelvic x-rays is typically used in trauma care to predict associated pelvic injuries, such as internal organ damage, and to guide care, such as external fixation of the pelvis. Crash site data on the direction of injuring forces don't always agree with pelvic x-rays, according to a pilot study. Nonetheless, given the limitations of pelvic x-rays, a study of crash site data in an attempt to improve patient triage or outcome is warranted, suggests Christopher C. Blackmore, M.D., M.P.H.

Dr. Blackmore and Harborview Medical Center coinvestigators compared crash site investigation data with pelvic x-rays of 28 victims of motor vehicle crashes. Crash site data included principal direction of force (PDOF), crash magnitude, and passenger compartment intrusion. The PDOF reflected a frontal crash in 32 percent and side impact in 68 percent of patients. The pelvic x-ray fracture pattern agreed with the crash site observation in a moderate proportion of cases for frontal impact cases (80 percent) and lateral impact cases (81 percent).

This implies that surgeons should have moderate confidence that pelvic fracture patterns seen on x-rays are a reflection of the principal direction of force from the crash. Crash site data are not currently used routinely for clinical decisions involving crash victims. However, digital images from motor vehicle crash sites are now available in some trauma centers when the emergency team begins resuscitating the trauma victim.

The researchers believe that crash site information potentially will aid emergency treatment of pelvic fractures and associated injuries, and call for further studies. Their study was supported in part by the Agency for Healthcare Research and Quality (HS11291).

See "Do initial radiographs agree with crash site mechanism of injury in pelvic ring disruptions? A pilot study," by Ken F. Linnau, M.D., M.P.H., Dr. Blackmore, Robert Kaufman, B.S., and others, in the July 2007 Journal of Orthopedic Trauma 21(6), pp. 375-380.

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