Management of pelvic ring fracture patients with a pelvic “blush” on early computed tomography

Verbeek, Diederik O.; Zijlstra, Ijsbrand A.J.; Leij, Christaan van der; Ponsen, Kornelis J.; Delden, Otto M. van; Goslings, J. C.

doi:10.1097/ta.0000000000000094

Cited by 52 publications

(38 citation statements)

References 20 publications

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“…(4,6,8,10) The incidence of blush-positive patients in the current is higher than that of other studies. (13,14) This difference could be caused by subject selection. Other studies were performed for the all pelvic fracture patients.…”

Section: Discussionmentioning

confidence: 99%

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Blush on Computed Tomography and Transcatheter Arterial Embolization in Pelvic Fracture

Gwak

Yoon

Lee

et al. 2016

Journal of Trauma and Injury

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Purpose:Bleeding is the primary cause of death after severe pelvic fracture. Transcatheter arterial embolization (TAE) is the mainstay of treatment for arterial bleeding. This study aimed to determine the frequency of bleeding by angiography of blush-positive pelvic fractures on computed tomography (CT) images. The bleeding arteries that were involved were investigated by pelvic angiography.Methods: This retrospective cohort study evaluated 83 pelvic fracture patients who were treated in the intensive care unit of the author's trauma center between January 01, 2013 and April 30, 2015.Results: Overall mortality was 9 of 83 patients (10.8%). Blush was observed in 37 patients; blush-positive patients had significantly higher mortality (24.3%) than blush-negative patients (0%). Twenty-four of the 83 patients (28.9%) underwent pelvic angiography. Bleeding was showed in 22 of 24 patients in pelvic angiography. TAE was successfully performed in 21 (95.5%) of the bleeding 22 patients. Angiography was performed in 23 of 37 blush-positive patients, and arterial bleeding was identified in 21 (91.3%). A total 33 bleeding arteries were identified in 22 angiography-positive patients. The most frequent origin of bleeding was internal iliac artery (69.7%) followed by the external iliac artery (18.2%) and lumbar arteries (12.1%). Conclusion:The vascular blush observed in CT scans indicates sites of ongoing bleeding in pelvic angiography. TAE is an excellent therapeutic option for arterial bleeding and has a high success rate with few complications. [ J Trauma Inj 2016; 29: 161-166 ]

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Section: Discussionmentioning

confidence: 99%

“…Other studies were performed for the all pelvic fracture patients. (13,14) However, this study only includes the pelvic fracture patients admitted to the intensive care unit of the author`s trauma center during the study period. Therefore, the pelvic fractures in this study could be more severe than that of other studies.…”

Section: Discussionmentioning

confidence: 99%

Blush on Computed Tomography and Transcatheter Arterial Embolization in Pelvic Fracture

Gwak

Yoon

Lee

et al. 2016

Journal of Trauma and Injury

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“…Hemodynamic instability and/or contrast extravasation at computer tomography (CT) examination are reliable indicators of arterial injury [6]. In patients with pelvic fractures, contrast extravasation on the arterial phase CT scans is encountered frequently; thereafter, the need for intervention seems to be determined by the presence of clinical signs of ongoing bleeding [7]. To improve survival of hemodynamically unstable patients with pelvic fractures, the hemorrhage must be stopped immediately [8].…”

Section: Introductionmentioning

confidence: 99%

The Role of Transcatheter Arterial Embolization in Traumatic Pelvic Hemorrhage: Not Only Pelvic Fracture

Comai¹,

Zatelli²,

Haglmüller³

et al. 2016

Cureus

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Purpose: The most common life-threatening complication of pelvic trauma is bleeding. Arterial bleedings frequently require active management, preferably with transcatheter arterial embolization (TAE). Hemodynamic instability and/or contrast extravasation at computer tomography (CT) examination are reliable indicators of arterial injury. Unstable pelvic fractures are much more hemorrhagic than stable fractures. Nevertheless, an absent or isolated pelvic fracture does not exclude pelvic hemorrhage.Materials and Methods: A retrospective study was conducted on our institutional database by collecting data of patients who underwent pelvic angiography and/or embolization due to pelvic blunt trauma in the period between August 2010 and August 2015.Results: In a period of five years, 39 patients with traumatic pelvic bleeding underwent angiography at our institution. Thirty-six of the 39 (92%) patients did show CT signs of active pelvic bleeding. Nineteen of 39 (49%) patients were hemodynamically unstable at presentation. Three of the 39 patients did not require embolization. Technical success was 35/36 (97%), and overall mortality was 3/39 (8%). Notably, 5/39 (13%) patients did not have any pelvic fracture at presentation, and 18/39 (46%) had only isolated or stable pelvic ring fracture.Conclusions: TAE is an effective technique to treat arterial pelvic bleeding after trauma. The absence of a major pelvic fracture does not exclude the risk of active bleeding requiring prompt treatment.

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“…Studies that have been done of angiography/embolization are difficult to directly compare with PPP because indications for intervention for pelvic fracture related hemorrhage or angiography vary from institution to institution; for example, some institutions send every unstable patient with a pelvic fracture directly to angiography, while some patients are excluded with a positive FAST; other institutions only send patients with a positive blush on CT scan, a large pelvic hematoma, or persistent hypotension [8, 9, 15•, 28, 37•, 45, 47•, 48, 49]. It has been recognized that a blush on CT scan is not a specific indicator of need for angioembolization [11]. While there is a role for angioembolization, there are potential deterrents to using this as a first-line treatment.…”

Section: Experiencementioning

confidence: 99%

“…A crucial point in the decision-making process, however, is identifying the pelvis as a possible site of post-traumatic bleeding. With one third of pelvic fracture-related mortality due to uncontrolled hemorrhage [10][11][12], early identification of this potential source during the evaluation is paramount. This permits institution of damage control resuscitation and operative techniques, if needed, to prevent early exsanguination and the lethal triad of hypothermia, coagulopathy, and acidosis that can follow hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Preperitoneal Pelvic Packing: How and When

Glass

Burlew

2014

Curr Trauma Rep

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Pelvic fractures can lead to life-threatening hemorrhage, particularly as they tend to occur in the setting of polytrauma. Several approaches to hemorrhage control have been employed in pelvic fracture patients over the years. This review describes the indications, operative technique, and outcomes for preperitoneal pelvic packing (PPP). Pelvic packing should be considered for every hemodynamically unstable patient with a significant pelvic fracture. We describe how this can be accomplished in coordination with other resuscitative efforts and operative needs.

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Management of pelvic ring fracture patients with a pelvic “blush” on early computed tomography

Abstract: Therapeutic study, level IV. Prognostic/epidemiologic study, level III.

Cited by 52 publications

References 20 publications

Blush on Computed Tomography and Transcatheter Arterial Embolization in Pelvic Fracture

Blush on Computed Tomography and Transcatheter Arterial Embolization in Pelvic Fracture

The Role of Transcatheter Arterial Embolization in Traumatic Pelvic Hemorrhage: Not Only Pelvic Fracture

Preperitoneal Pelvic Packing: How and When

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