Pelvic fracture patterns and their corresponding angiographic sources of hemorrhage

Metz, Christopher M.; Hak, David J.; Goulet, James A.; Williams, David

doi:10.1016/j.ocl.2004.06.002

Cited by 52 publications

(17 citation statements)

References 16 publications

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“…The incidence of PFRAB varies with the patient group and timing of the angiogram with a wide range of values between 10% and 92% 11,13–15. In our study, PFRAB occurred in 10% of the patients with pelvic fractures associated with high-energy mechanisms.…”

Section: Discussionmentioning

confidence: 50%

Factors Associated With Pelvic Fracture-Related Arterial Bleeding During Trauma Resuscitation

Tóth

King

McGrath

et al. 2014

Journal of Orthopaedic Trauma

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Objectives:To determine predictors of pelvic fracture-related arterial bleeding (PFRAB) from the information available in the Emergency Department (ED).Design:Prospective cohort study.Setting:Single level-1 Trauma Center.Patients:In a 3-year period ending in December 2008, consecutive high-energy pelvic fracture patients older than 18 years were included. Patients who arrived >4 hours after injury or dead on arrival were excluded. Patient management followed advanced trauma life support and institutional guidelines. Collected data included patient demographics, mechanism of injury, vital signs, acid-base status, fluid resuscitation, trauma scores, fracture patterns, procedures, and outcomes. Potential predictors were identified using standard statistical tests: Univariate analysis, Pearson correlation (r), receiver operator characteristic, and decision tree analysis.Intervention:Observational study.Outcome Measures:PFRAB was determined based on angiography or computed tomography angiogram or laparotomy findings.Results:Of the 143 study patients, 15 (10%) had PFRAB. They were significantly older, more severely injured, more hypotensive, more acidotic, more likely to require transfusions in the ED, and had higher mortality rate than non-PFRAB patients. No single variable proved to be a strong predictor but some had a significant correlation with PFRAB. Useful predictors identified were worst base deficit (BD), receiver operator characteristic (0.77, cutoff: 6 mmol/L, r = 0.37), difference between any 2 measures of BD within 4 hours (ΔBD) >2 mmol/L, transfusion in ED (yes/no), and worst systolic blood pressure <104 mm Hg. Demographics, injury mechanism, fracture pattern, temperature, and pH had poor predictive value.Conclusions:BD <6 mmol/L, ΔBD >2 mmol/L, systolic blood pressure <104 mm Hg, and the need for transfusion in ED are independent predictors of PFRAB in the ED. These predictors can be valuable to triage blunt trauma victims for pelvic hemorrhage control with angiography.Level of Evidence:Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 50%

Factors Associated With Pelvic Fracture-Related Arterial Bleeding During Trauma Resuscitation

Tóth

King

McGrath

et al. 2014

Journal of Orthopaedic Trauma

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“…8,9 However, it is generally agreed that anterior fractures are associated with anterior vascular injuries, whereas posterior fractures are associated with posterior vascular injuries. 10 Angiography for pelvic fractures allows both selective embolization of bleeding arteries and nonselective embolization of the more proximal internal iliac arteries. Multiple bleeding sites from bilateral internal iliac artery branches are sometimes identified, especially in hemodynamically unstable patients.…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary Management of Blunt Pelvic Trauma

Khanna¹,

Phan

Hardy³

et al. 2012

Semin intervent Radiol

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Pelvic fractures account for ∼3% of all fractures and usually occur in patients with polytrauma. Pelvic fractures usually indicate high energy transfer and a significant mechanism of injury, and they can involve massive hemorrhage. For this reason, mortality from pelvic trauma is high, ranging from 40% to 60% among patients in shock, and up to 90% in patients considered to be in extremis. Multidisciplinary approaches in the treatment of patients with pelvic fractures have resulted in improved outcomes for these complex and challenging injuries. In this article, we describe a case of a pediatric patient who suffered severe pelvic fracture with massive hemorrhage, requiring a multidisciplinary approach for control of hemorrhage and definitive repair of injuries.

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“…Entretanto, pacientes que persistem com choque após reanimação volêmica adequada e estabilização mecânica da pelve são os que possuem maior probabilidade de apresentar lesão arterial (110) . Entre estes pacientes, estudos demonstram a presença de lesão arterial em mais de 50% dos casos (30,37,62,76,(111)(112) , sendo esta situação a indicação mais comum da realização da arteriografia (34) (13, 18, 20, 30-32, 36, 40, 42) . O tratamento multidisciplinar das lesões pélvicas com realização do TXP não impede a realização de arteriografia complementar.…”

Section: Segmentos Corpóreosunclassified

Análise dos resultados do tratamento multidisciplinar de pacientes com fratura pélvica e choque, submetidos ao tamponamento extraperitoneal de pelve, no Hospital das Clínicas da FMUSP

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Pelvic fracture patterns and their corresponding angiographic sources of hemorrhage

Cited by 52 publications

References 16 publications

Factors Associated With Pelvic Fracture-Related Arterial Bleeding During Trauma Resuscitation

Factors Associated With Pelvic Fracture-Related Arterial Bleeding During Trauma Resuscitation

Multidisciplinary Management of Blunt Pelvic Trauma

Análise dos resultados do tratamento multidisciplinar de pacientes com fratura pélvica e choque, submetidos ao tamponamento extraperitoneal de pelve, no Hospital das Clínicas da FMUSP

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