Detection of bleeding in patients with major pelvic fractures: value of contrast-enhanced CT.

Cerva, Donald; Mirvis, Stuart E.; Shanmuganathan, K.; Kelly, Ian; Pais, S. Osher

doi:10.2214/ajr.166.1.8571861

Cited by 103 publications

(39 citation statements)

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“…[12][13][14][15] However, not all patients with arterial bleeding demonstrate active extravasation on CT. Demonstration of arterial extravasation on CT requires multislice CT scanning with an optimized technique in the arterial phase, which may not be possible in all trauma patients.…”

Section: Commentmentioning

confidence: 99%

Assessment of Volume of Hemorrhage and Outcome From Pelvic Fracture

et al. 2003

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Hypothesis: Measurement of pelvic hemorrhage on computed tomographic (CT) scans can estimate the pelvic fracture component of total patient blood loss and predict the need for angiography.Design: Retrospective cohort study.Setting: Large level 1 trauma center.Patients: We examined data from 759 consecutive, nonreferral blunt trauma patients who sustained pelvic fracture.Main Outcome Measures: Pelvic-fracture-specific outcomes included estimation of extraperitoneal pelvic hemorrhage volume from emergency department CT scans and determination of arterial injury from angiograms. General patient outcomes determined from medical record review included transfusion requirement, estimated blood loss, and mortality. Subanalysis was performed on subjects with only pelvic fracture as a source of major hemorrhage (derived from discharge International Classification of Diseases, Ninth Revision, Clinical Modification codes).Results: Overall mortality was 96 (13%) of 759 patients. Blood transfusion was given to 418 (55%) patients, and 258 (34%) received 6 or more units in the first 72 hours. Pelvicfracture-related hemorrhage averaged 149 mL (range, 0-1423 mL). Angiography was performed on 163 patients, of whom 113 had arterial injury. Higher pelvic hemorrhage volumes on CT scans were seen in subjects with pelvic arterial injury demonstrated on angiograms (PϽ.001). In subjects without another source of major hemorrhage, pelvic CT hemorrhage volumes were strongly associated with transfusion requirement (PϽ.001). Subjects with large pelvic hemorrhage volumes (Ͼ500 mL) were more likely to have pelvic arterial injury (risk ratio, 4.8; 95% confidence interval, 3.0-7.8; PϽ.001) and require largevolume (Ն6 U) transfusions (risk ratio, 4.7; 95% confidence interval, 1.8-12.3; PϽ.001) than patients with smaller pelvic hemorrhage volumes. Conclusion:Pelvic hemorrhage volumes derived from pelvic CT scans were predictors of the need for pelvic arteriography and transfusions.

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Section: Commentmentioning

confidence: 99%

Assessment of Volume of Hemorrhage and Outcome From Pelvic Fracture

et al. 2003

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“…It is possible to detect critical vascular injuries including direct signs of vascular injury [3,4,5], diminished or occluded organ perfusion, active bleeding [4,6,7,8], and pseudoaneurysms [3,9]. The severity of bleeding and the need for intervention may be graded according to Taylor [10].…”

Section: Why Whole-body Ct?mentioning

confidence: 99%

Standardized whole-body computed tomography as a screening tool in blunt multitrauma patients

Leidner

Beckman

2001

Emergency Radiology

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The authors present the potential of using a preset CT protocol covering the whole body of the patient who has suffered blunt trauma to screen for injuries, based on a review of the literature and on 4 years' direct experience. Standardized whole-body CT is the fastest method of examining the whole body, capable of detecting a wide variety of traumatic lesions with a high sensitivity and specificity. Multidetector CT allows a full-body examination to be completed within 5 min, thus minimizing time to diagnosis and the institution of definitive clinical care. Current imaging algorithms that include abdominal ultrasonography and plain radiographic studies need to be reassessed in view of the technical advances in CT diagnosis, but should ultimately depend on the particular imaging capabilities and experience of a given trauma center.

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“…Numerous reports have described new clinical applications of spiral CT and improvements in the technique for imaging of trauma patients with proven advantages compared to the earlier sequential CT techniques [2,3,4,5,6]. However, the question as to whether trauma patients really benefit from the more advanced technical equipment and the obvious advantages spiral CT can provide, especially the faster working scanners [7] has remained open.…”

Section: Introductionmentioning

confidence: 99%

New method for fast spiral CT of trauma patients: RUSH CT

Linsenmaier

Rieger

Brandl

et al. 2000

Emergency Radiology

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Aim: The purpose of this study was to develop a fast scanning protocol for spiral CT of emergency trauma patients (RUSH-CT) in order to accelerate the diagnostic work-up. Method: In a consecutive series 446 trauma patients underwent spiral CT; of these, 51 emergency patients underwent a modified protocol (RUSH-CT) on a recent technology scanner (Somatom Plus 4). Scanning time was compared between the RUSH-CT and the regular protocols. Results: The average time for RUSH-CT, comprising one pilot scan and three spiral scans, including preparation time and monitor reading was 15 min (range 12±18 min; n = 51). Using regular organ protocols comprising two pilot scans and four spiral scans, the control group had an average scanning time of 35 min. In comparison to the conventional organ protocols, total scanning time could be reduced by the RUSH-CT by 57 % (P < 0.01). Conclusion: Fast spiral CT (RUSH-CT) significantly reduces the time needed for diagnostic work-up and allows early therapeutic intervention. CT diagnosis can be completed within the first 30 min after the patient's admission.

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Detection of bleeding in patients with major pelvic fractures: value of contrast-enhanced CT.

Cited by 103 publications

References 0 publications

Assessment of Volume of Hemorrhage and Outcome From Pelvic Fracture

Assessment of Volume of Hemorrhage and Outcome From Pelvic Fracture

Standardized whole-body computed tomography as a screening tool in blunt multitrauma patients

New method for fast spiral CT of trauma patients: RUSH CT

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