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Injury. 2018 Feb;49(2):279-283. doi: 10.1016/j.injury.2017.10.009. Epub 2017 Oct 9.

Straight leg elevation to rule out pelvic injury.

Author information

1
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. Electronic address: carolinebolt83@gmail.com.
2
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.

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:

Clinical Decision-making; Computer tomography; Diagnostic techniques & procedures; Fractures; Leg; Multiple trauma; Pelvic bones; Pelvis; Physical examination; Radiography; Shock; Traumatic; Whole body imaging

PMID:
29132904
DOI:
10.1016/j.injury.2017.10.009
[Indexed for MEDLINE]

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