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Straight leg elevation to rule out pelvic injury

  • Caroline Bolt
    Correspondence
    Corresponding author.
    Affiliations
    Emergency & Trauma Centre, The Alfred Hospital, Department of Epidemiology & Preventive Medicine, Monash University, National Trauma Research Institute, The Alfred Hospital Commercial Road, Melbourne, Victoria, 3004, Australia
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  • Francis O’Keeffe
    Affiliations
    Emergency & Trauma Centre, The Alfred Hospital, Department of Epidemiology & Preventive Medicine, Monash University, National Trauma Research Institute, The Alfred Hospital Commercial Road, Melbourne, Victoria, 3004, Australia
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  • Pete Finnegan
    Affiliations
    Emergency & Trauma Centre, The Alfred Hospital, Department of Epidemiology & Preventive Medicine, Monash University, National Trauma Research Institute, The Alfred Hospital Commercial Road, Melbourne, Victoria, 3004, Australia
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  • Kristofer Dickson
    Affiliations
    Emergency & Trauma Centre, The Alfred Hospital, Department of Epidemiology & Preventive Medicine, Monash University, National Trauma Research Institute, The Alfred Hospital Commercial Road, Melbourne, Victoria, 3004, Australia
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  • De Villiers Smit
    Affiliations
    Emergency & Trauma Centre, The Alfred Hospital, Department of Epidemiology & Preventive Medicine, Monash University, National Trauma Research Institute, The Alfred Hospital Commercial Road, Melbourne, Victoria, 3004, Australia
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  • Mark C. Fitzgerald
    Affiliations
    Emergency & Trauma Centre, The Alfred Hospital, Department of Epidemiology & Preventive Medicine, Monash University, National Trauma Research Institute, The Alfred Hospital Commercial Road, Melbourne, Victoria, 3004, Australia
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  • Biswadev Mitra
    Affiliations
    Emergency & Trauma Centre, The Alfred Hospital, Department of Epidemiology & Preventive Medicine, Monash University, National Trauma Research Institute, The Alfred Hospital Commercial Road, Melbourne, Victoria, 3004, Australia
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Published:October 09, 2017DOI:https://doi.org/10.1016/j.injury.2017.10.009

      Abstract

      Objective

      Pelvic 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.

      Methods

      We 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.

      Results

      Of 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.

      Conclusion

      Among awake, alert patients, painless straight leg raise can exclude pelvic fractures and be incorporated into initial examination during reception and resuscitation of injured patients.

      Keywords

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