Straight leg elevation to rule out pelvic injury |
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| Affiliation: | 1. Department of Physiotherapy, The Alfred, Melbourne, Australia;2. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia;3. Department of Renal Medicine, The Alfred, Melbourne, Australia;4. Baker IDI, Melbourne, Australia;5. Department of Medicine, Monash University, Melbourne, Australia;6. Victorian Adult Burns Service, The Alfred, Melbourne, Australia;7. Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia;1. Dartmouth Hitchcock Medical Center, Department of Orthopaedic Surgery, Dartmouth Geisel School of Medicine, Hanover, NH, United States;2. R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, United States;1. Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden;2. Clinical and Molecular Research Unit, Departments of Orthopedics and Clinical Sciences, Skåne University Hospital Malmö, Lund University, Malmö, Sweden;3. Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA |
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| Abstract: | ![]()
ObjectivePelvic x-ray is frequently used as a screening tool during initial assessment of injured patients. However routine use in the awake and alert blunt trauma patient may be questioned due to low yield. We propose a clinical tool that may avoid unnecessary imaging by examining whether the ability to straight leg raise, without pain, can rule out pelvic injury.MethodsWe conducted a prospective cohort study with the exposure variables of ability to straight leg raise and presence of pain on doing so, and presence of pelvic fracture on x-ray as the primary outcome variable.ResultsOf the 328 participants, 35 had pelvic fractures, and of these 32 were either unable to straight leg raise, or had pain on doing so, with a sensitivity of 91.43% (95% CI: 76.94–98.2%) and a negative predictive value of 98.57% (95% CI: 95.88–99.70%). The 3 participants with a pelvic fracture who could straight leg raise with no pain, all had a GCS of less than 15, and therefore, among the sub-group of patients with GCS15, a 100% sensitivity and 100% negative predictive value for straight leg raise with no pain to rule out pelvic fracture was demonstrated.ConclusionAmong awake, alert patients, painless straight leg raise can exclude pelvic fractures and be incorporated into initial examination during reception and resuscitation of injured patients. |
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| Keywords: | Clinical Decision-making Diagnostic techniques & procedures Radiography Computer tomography Multiple trauma Shock Traumatic Fractures Pelvis Pelvic bones Leg Whole body imaging Physical examination Fractures Pelvis |
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