Abstract
Background. The purpose of this study was to evaluate the use of dynamic helical computed tomography
(CT) scan for screening patients with pelvic fractures and hemorrhage requiring angiographic
embolization for control of bleeding. Methods. Patients admitted to the trauma service with pelvic fractures were identified from
the trauma registry. Data retrieval included demographics, hemodynamic instability,
Injury Severity Score, blood transfusion requirement, length of stay, and mortality.
CT scans obtained during the initial evaluation were reviewed for the presence of
contrast extravasation and correlated with angiographic findings. Data are reported
as mean ± SEM, with P <.05 considered significant. Results. Seven thousand seven hundred eighty-one patients were admitted from June 1994 to
May 1999. A pelvic fracture was diagnosed in 660 (8.5%). Two hundred ninety (44.0%)
dynamic helical CT scans were performed, of which 13 (4.5%) identified contrast extravasation.
Nine (69%) were hemodynamically unstable and had pelvic arteriography performed. Arterial
bleeding was confirmed in all and controlled by embolization. Patients with contrast
extravasation had significantly greater Injury Severity Score, blood transfusion requirement
and length of stay. Sensitivity, specificity, and accuracy of CT scan for identifying
patients requiring embolization were 90.0%, 98.6%, and 98.3%, respectively. Conclusion. Early use of dynamic helical CT scanning in the multiply injured patient with a pelvic
fracture accurately identifies the need for emergent angiographic embolization. (Surgery
2000;128:67885.)
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References
- Hemorrhage in major pelvic fractures.Surg Clin North Am. 1988; 68: 757-773
- Pelvic ring disruptions: effective classification system and treatment protocols.J Trauma. 1990; 30: 848-856
- Definitive control of mortality from severe pelvic fracture.Ann Surg. 1990; 211: 703-706
- Pelvic fracture classification: correlation with hemorrhage.J Trauma. 1988; 28: 973-980
- Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome.J Trauma. 1989; 29: 9811000
- The mortality associated with pelvic fractures.Surgery. 1978; 84: 356-361
- Causes of mortality in patients with pelvic fractures.Orthopedics. 1994; 17: 691-696
- Pelvic fracture hemorrhage: priorities in management.Arch Surg. 1989; 124: 422-424
- A protocol for the initial management of unstable pelvic fractures.Am Surg. 1998; 64: 862-867
- The management of complex orthopedic injuries.Surg Clin North Am. 1996; 76: 879-903
- Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage.J Trauma. 1997; 43: 395-399
- Percutaneous transcatheter embolization for massive bleeding from pelvic fractures.J Trauma. 1985; 25: 1021-1029
- Pelvic fracture hemorrhage: current strategies in diagnosis and management.Surg Annu. 1995; 27: 107-112
- The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.J Trauma. 1974; 14: 187-196
- Fracture of the pelvis: current concepts of classification.Am J Roentgenol. 1990; 155: 1169-1175
- Hemorrhage associated with major pelvic fracture: a multi-specialty challenge.J Trauma. 1986; 26: 987-994
- Hemorrhage associated with pelvic fractures: causes, diagnosis, and emergent management.Am J Roentgenol. 1991; 157: 1005-1014
- Detection of bleeding in patients with major pelvic fractures: value of contrast-enhanced CT.Am J Roentgenol. 1996; 166: 131-135
- Early detection of arterial bleeding in acute pelvic trauma.J Trauma. 1999; 47: 638-642
Article info
Footnotes
*Reprint requests: Fred A. Luchette, MD, Division of Trauma and Critical Care, Department of Surgery, 231 Bethesda Ave, Cincinnati, OH 45267.
**Surgery 2000;128:67885
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
