UMEM Educational Pearls

Of pediatric patients who have anteroposterior (AP) pelvic xrays (XR), there is a 4.6% rate of pelvic fracture or dislocation, compared to 10% in adults.

This study is a sub analysis of a prospective observational cohort of children with blunt torso trauma conducted by PECARN. 7808 patients had pelvic imaging, with 65% of them having an AP XR. The XR sensitivity ranged from 64-82% (based on age groups) for detecting fractures. All but one patient with a pelvic fracture not detected on XR had a CT scan. The CT scan detected all but 2 fractures both of which were picked up later as healing fractures on repeat pelvic XR. Some of the patients who had a missed fracture on XR were hemodynamically unstable or wound up requiring operative intervention.

The authors support the following algorithm:

-With hemodynamically unstability children, obtain a pelvic XR

-For hemodynamically stable children when the physician is planning to get a CT, there is no indication for XR

Bottom line: Consider using AP pelvic radiographs in the hemodynamically stable patient with a high suspicion for fracture or dislocation who are not undergoing CT.


Kwok et al. Sensitivity of Plain Pelvis Radiography in Children with Blunt Torso Trauma. Annals of Emergency Medicine 2015; 65: 63-71.