Sauerland Stefan, Bouillon Bertil, Rixen Dieter, Raum Marcus R, Koy Timmo, Neugebauer Edmund A M
2nd Department of Surgery, University of Cologne, Ostmerheimer Str. 200, 51109, Cologne, Germany.
Arch Orthop Trauma Surg. 2004 Mar;124(2):123-8. doi: 10.1007/s00402-003-0631-8. Epub 2004 Jan 27.
Several studies have recently questioned whether routine radiographic screening for pelvic fractures is necessary in the initial evaluation of blunt trauma patients. Therefore, we assessed how sensitive and specific the clinical examination is in detecting fractures of the pelvis.
We extensively searched various medical databases for studies that reported on the accuracy of pelvic examination in severely injured adults or children. Individual study results were summarized in a receiver operating characteristics (ROC) curve and pooled in a meta-analysis.
Twelve studies with a total of 5454 patients met our inclusion criteria and provided data in sufficient detail. Pooled sensitivity and specificity were 0.90 (95% confidence interval: 0.85-0.93) and 0.90 (0.84-0.94), respectively. Results were better in those studies which excluded neurologically impaired patients [e.g., Glasgow Coma Scale (GCS) <13]. Among the 49 false negative cases whose fractures went undetected on clinical examination, the majority of patients had either altered consciousness or minor pelvic fracture only. Only 3 clinically relevant pelvic fractures were missed among 441 patients with fracture within a total population of 5235 patients.
In stable and alert trauma patients, a thorough clinical examination will detect pelvic fractures with nearly 100% sensitivity, thus rendering initial radiography unnecessary in this group of patients.
最近有多项研究对在钝性创伤患者的初始评估中进行骨盆骨折的常规影像学筛查是否必要提出了质疑。因此，我们评估了临床检查在检测骨盆骨折方面的敏感性和特异性。
我们广泛检索了各种医学数据库，以查找报告严重受伤的成人或儿童骨盆检查准确性的研究。将个体研究结果汇总在受试者工作特征（ROC）曲线中，并进行荟萃分析。
12项研究共纳入5454例患者，符合我们的纳入标准，并提供了足够详细的数据。汇总的敏感性和特异性分别为0.90（95%置信区间：0.85 - 0.93）和0.90（0.84 - 0.94）。在排除神经功能受损患者[例如，格拉斯哥昏迷量表（GCS）<13]的研究中，结果更好。在临床检查未发现骨折的49例假阴性病例中，大多数患者意识改变或仅为轻度骨盆骨折。在5235例患者的总体中，441例骨折患者中仅漏诊了3例具有临床意义的骨盆骨折。
在病情稳定且意识清醒的创伤患者中，全面的临床检查将以近100%的敏感性检测出骨盆骨折，因此在这类患者中无需进行初始X线检查。
