Dynamic helical computed tomography scan accurately detects hemorrhage in patients with pelvic fracture

Pereira, Sara J.; O’Brien, David; Luchette, Fred A.; Choe, Kyuran A.; Lim, Edward V. A.; Davis, Kenneth; Hurst, James Willard; Johannigman, Jay A.; Frame, Scott B.

doi:10.1067/msy.2000.108219

Cited by 156 publications

(80 citation statements)

References 15 publications

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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: 98%

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: 98%

Assessment of Volume of Hemorrhage and Outcome From Pelvic Fracture

et al. 2003

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“…The results are questionable as most of the studies focused on the more severe fracture patterns (VS, APCIII injuries) [3,19,20,26,37,[45][46][47]. However, at the same time other studies reported major pelvic bleeding secondary to less severe types of pelvic ring fractures [41-44, 48, 49].…”

Section: Discussionmentioning

confidence: 49%

Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature

Karadimas

Nicolson

Kakagia

et al. 2011

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the relation between pelvic fracture patterns and the angiographic findings, and to assess the effectiveness of the embolisation. Methods This retrospective study, included patients with pelvic fractures and angiographic evaluation. Demographics, Injury Severity Score (ISS), associated injuries, embolisation time, blood units needed, method of treatment and complications were recorded and analysed. Fractures were classified according to the Burgess system. Results Between 1998 and 2008, 34 patients with pelvic fractures underwent angiographic investigation. Twenty six were males. The mean age was 41 years. Twenty-seven were motor vehicle accidents and seven were falls. There were 11 anterior posterior (APC) fractures, 12 lateral compression (LC), eight vertical shear (VS) patterns and three with combined mechanical injuries. The median ISS was 33.1 (range 5-66). From the 34 who underwent angiography, 29 had positive vascular extravasations. From them, 21 had embolisation alone, two had vascular repair and embolisation, five required vascular repair alone and one patient died while being prepared for embolisation. Five cases were re-embolised. The findings suggested that AP fractures have a higher tendency to bleeding compared with LC fractures. Both had a higher chance of blood loss compared to VS and complex fracture patterns. We reported 57 additional injuries and 65 fractures. The complications were: one non lethal pulmonary embolism, one renal failure, one liver failure, one systemic infection, two deep infections and two psychological disorientations. Seven patients died in hospital. Conclusion Control of pelvic fracture bleeding is based on the multidisciplinary approach mainly related to hospital facilities and medical personnel's awareness. The morphology of the fracture did not have a predictive value of the vascular lesion and the respective bleeding.

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“…This approach has been shown to lead to improved outcomes in large studies [29]. Normotensive patients with suspected ongoing interstitial or parenchymal bleeding are often assessed using computed tomography (CT) scans to localize target areas for IR [30]. The rapid appearance of a ''blush'' is best seen on early-phase CT scans.…”

Section: Angiographic Embolization Of Bleedingmentioning

confidence: 99%

Technological advancements in the care of the trauma patient

Siracuse

Saillant

Hauser

2011

Eur J Trauma Emerg Surg

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The advances in trauma care are in great measure due to the integration of many different systems. Medical technology impacts care in the field at the site of the trauma, in the transport to trauma facilities, and care at the trauma center itself. Once at the hospital, technology has impacted care in the trauma bay, intensive care units, the operating room, and in postoperative and long-term care settings. The integration of advancements, however, needs to be examined in a careful systematic fashion to insure that patients will actually derive benefit.

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Dynamic helical computed tomography scan accurately detects hemorrhage in patients with pelvic fracture

Cited by 156 publications

References 15 publications

Assessment of Volume of Hemorrhage and Outcome From Pelvic Fracture

Assessment of Volume of Hemorrhage and Outcome From Pelvic Fracture

Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature

Technological advancements in the care of the trauma patient

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