Use of computed tomography findings and contrast extravasation in predicting the need for embolization with pelvic fractures

Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.
The American surgeon (Impact Factor: 0.82). 08/2012; 78(8):825-30.
Source: PubMed


Transarterial embolization (AE) can be a lifesaving procedure for severe hemorrhage associated with pelvic fractures. The purpose of this study was to identify demographic and radiographic findings that predict the need for embolization. We performed a retrospective review of all patients with at least one pelvic fracture and admission to the intensive care unit over a 35-month period. Computed tomography (CT) and pelvic radiographs were reviewed. Patient demographics, outcomes, time to angiography, and whether or not embolization was performed were determined. Statistical analysis was used to determine factors associated with the need for AE. Of the 327 total patients with pelvic fractures, 317 underwent CT scanning. Forty-four patients (13.5%) underwent angiography and 25 (7.6%) required therapeutic embolization. There were 39 total deaths (11.6%) with five deaths related to pelvic hemorrhage (1.5%). Multivariate analysis revealed that age older than 55 years (odds ratio [OR], 1.06; P < 0.001), systolic blood pressure less than 90 mmHg in the emergency department (OR, 11.64; P = 0.0008), and CT extravasation (OR, 147.152; P < 0.0001) were significantly associated with the need for embolization. Contrast extravasation was not present in 25 per cent of patients requiring therapeutic AE. The presence of contrast extravasation is highly associated with the need for pelvic embolization in patients with pelvic fractures, but its absence does not exclude the need for pelvic angiography.

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    • "However, most of these parameters were determined in selected patients with an isolated pelvic fracture. Contrast media extravasation on pelvic CT scan has also been identified as a strong predictor for embolization [17] [21]. However, the utility of the CT scan as a screening instrument has been questioned since the general consensus is that haemodynamically unstable patients be not considered for CT scanning and stable patients with a pelvic arterial blush on CT probably would not benefit from angiography [2]. "
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