|
Clinical Examination of the pelvis
is used to assess for mechanical instability. However the
sensitivity and specificity of this test have been called
into question. In addition, opening and closing the pelvis
may destabilise clot that has formed and provoke fresh haemorrhage:
Trauma-list
Mailing List:
"Preserve clot
[...] Punch anyone who tries to spring the pelvis"
Tim Coats
Royal London Hospital
> How are pre-hospital
people treating pelvic fractures in your area?
Preserve clot -
minimal movement, gentle handling, minimum of rolling. Punch
anyone who tries to 'spring' the pelvis. Fit pelvic belt
on basis of mechanism of injury. Minimal iv fluid to preserve
systolic of 70 (90 mmHg if associated head injury). Take
to a hospital that understands the condition!
Timothy J Coats
MD FRCS FFAEM
Senior Lecturer in Accident and Emergency/Pre-Hospital Care
Royal London Hospital, UK.
Evidence
Grant PT "The diagnosis
of pelvic fractures by 'springing'." Arch Emerg Med
1990 7(3): 178-182.
Thirty-six patients were studied
prospectively to assess the benefit of 'springing' the pelvis
in traumatized patients, to confirm or refute a fracture
of the pelvis. None of the patients was multiply injured
and half of those with fractures were elderly, sustaining
their injuries in simple falls. Springing the pelvis was
a poor predictor of the presence or absence of a pelvic
fracture, at best it yielded a specificity of 71% and sensitivity
of 59%. Its routine use in clinical examination should be
abandoned.
Guide to Evidence Appraisals
The definitions of the types of evidence
and the grading of recommendations used originate from the
US Agency for Health Care Policy and Research
| Evidence
obtained from meta-analysis of randomised controlled
trials |
| Evidence
obtained from at least one randomised controlled trial |
| Evidence
obtained from at least one well-designed controlled
study without randomisation |
| Evidence
obtained from at least one other type of well-designed
quasi-experimental study |
| Evidence
obtained from well-designed non-experimental descriptive
studies, such as comparative studies, correlation studies
and case control studies |
| Evidence
obtained from expert committee reports or opinions and/or
clinical experience of respected authorities |
|
