Physical Exam Reliably Detects Unstable Pelvic Fractures Only If GCS Score Is 14 or 15

Patients with GCS scores ≥14 and no pelvic pain or tenderness are very unlikely to have unstable fractures.

Standard trauma references state that physical examination for pelvic ring stability is indicated in patients with blunt trauma, but supportive evidence for this practice is scant. To assess the usefulness of such examinations for detecting unstable pelvic fractures (defined as Tile type B or C fractures), researchers retrospectively reviewed charts of patients who met criteria for trauma team activation at a single level I trauma center in Los Angeles from 2003 to 2005. Senior surgery residents conducted the examinations, and a resident and a dedicated nurse scribe recorded findings for each exam on a standardized data sheet.

Examining residents clinically excluded fracture in 332 patients (242 with penetrating injury and 90 with blunt inju…

Reviewing Author

John A. Marx, MD, FAAEM, FACEP