Skip to main content
Top
Published in: Japanese Journal of Radiology 3/2018

01-03-2018 | Original Article

Predictors of active arterial hemorrhage on angiography in pelvic fracture patients

Authors: Ying-Chieh Lai, Cheng-Hsien Wu, Huan-Wu Chen, Li-Jen Wang, Yon-Cheong Wong

Published in: Japanese Journal of Radiology | Issue 3/2018

Login to get access

Abstract

Purpose

To determine predictors of active angiographic hemorrhage in pelvic fracture patients.

Materials and methods

This retrospective study included 66 trauma patients who had major hemorrhages due to pelvic fractures, and who underwent pelvic angiography between January 2012 and December 2014. The study population comprised 31 males and 35 females (mean age 44.2 ± 20.7 years). The main outcome was active hemorrhage on pelvic angiography. Clinical and imaging variables including demographics, hemodynamic parameters, injury severity, types of pelvic fracture, laboratory data, blood transfusions and CT findings were analyzed. Multivariate logistic regression was used to identify predictors of active angiographic hemorrhage.

Results

Of the 66 study patients included, 41 patients had active angiographic hemorrhage. These patients had more blood transfusions, higher activated partial thromboplastin times and higher rates of contrast extravasation on CT (p < 0.05). Three independent predictors of active angiographic hemorrhage were identified, including contrast extravasation on CT (OR: 74.6, p < 0.001), more than 8 units of RBC transfusions (OR: 12.5, p = 0.018) and ISS ≥ 16 (OR: 11.1, p = 0.029).

Conclusion

Contrast extravasation on CT, high volume RBC transfusions and ISS ≥ 16 can help us to select pelvic fracture patients for angiography more precisely.
Literature
1.
go back to reference Sathy AK, Starr AJ, Smith WR, Elliott A, Agudelo J, Reinert CM, et al. The effect of pelvic fracture on mortality after trauma: an analysis of 63,000 trauma patients. J Bone Jt Surg Am Vol. 2009;91(12):2803–10.CrossRef Sathy AK, Starr AJ, Smith WR, Elliott A, Agudelo J, Reinert CM, et al. The effect of pelvic fracture on mortality after trauma: an analysis of 63,000 trauma patients. J Bone Jt Surg Am Vol. 2009;91(12):2803–10.CrossRef
2.
go back to reference Vaidya R, Scott AN, Tonnos F, Hudson I, Martin AJ, Sethi A. Patients with pelvic fractures from blunt trauma. What is the cause of mortality and when? Am J Surg. 2016;211(3):495–500.CrossRefPubMed Vaidya R, Scott AN, Tonnos F, Hudson I, Martin AJ, Sethi A. Patients with pelvic fractures from blunt trauma. What is the cause of mortality and when? Am J Surg. 2016;211(3):495–500.CrossRefPubMed
3.
go back to reference Fangio P, Asehnoune K, Edouard A, Smail N, Benhamou D. Early embolization and vasopressor administration for management of life-threatening hemorrhage from pelvic fracture. J Trauma. 2005;58(5):978–84 (discussion 84).CrossRefPubMed Fangio P, Asehnoune K, Edouard A, Smail N, Benhamou D. Early embolization and vasopressor administration for management of life-threatening hemorrhage from pelvic fracture. J Trauma. 2005;58(5):978–84 (discussion 84).CrossRefPubMed
4.
go back to reference Li Q, Dong J, Yang Y, Wang G, Wang Y, Liu P, et al. Retroperitoneal packing or angioembolization for haemorrhage control of pelvic fractures—quasi-randomized clinical trial of 56 haemodynamically unstable patients with Injury Severity Score ≥33. Injury. 2016;47(2):395–401.CrossRefPubMed Li Q, Dong J, Yang Y, Wang G, Wang Y, Liu P, et al. Retroperitoneal packing or angioembolization for haemorrhage control of pelvic fractures—quasi-randomized clinical trial of 56 haemodynamically unstable patients with Injury Severity Score ≥33. Injury. 2016;47(2):395–401.CrossRefPubMed
5.
go back to reference Salim A, Teixeira PG, DuBose J, Ottochian M, Inaba K, Margulies DR, et al. Predictors of positive angiography in pelvic fractures: a prospective study. J Am Coll Surg. 2008;207(5):656–62.CrossRefPubMed Salim A, Teixeira PG, DuBose J, Ottochian M, Inaba K, Margulies DR, et al. Predictors of positive angiography in pelvic fractures: a prospective study. J Am Coll Surg. 2008;207(5):656–62.CrossRefPubMed
6.
go back to reference Cullinane DC, Schiller HJ, Zielinski MD, Bilaniuk JW, Collier BR, Como J, et al. Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture—update and systematic review. J Trauma. 2011;71(6):1850–68.PubMed Cullinane DC, Schiller HJ, Zielinski MD, Bilaniuk JW, Collier BR, Como J, et al. Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture—update and systematic review. J Trauma. 2011;71(6):1850–68.PubMed
7.
go back to reference Huber-Wagner S, Lefering R, Qvick LM, Korner M, Kay MV, Pfeifer KJ, et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009;373(9673):1455–61.CrossRefPubMed Huber-Wagner S, Lefering R, Qvick LM, Korner M, Kay MV, Pfeifer KJ, et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009;373(9673):1455–61.CrossRefPubMed
8.
go back to reference Bougle A, Harrois A, Duranteau J. Resuscitative strategies in traumatic hemorrhagic shock. Ann Intensiv Care. 2013;3(1):1.CrossRef Bougle A, Harrois A, Duranteau J. Resuscitative strategies in traumatic hemorrhagic shock. Ann Intensiv Care. 2013;3(1):1.CrossRef
9.
go back to reference Lustenberger T, Wutzler S, Stormann P, Laurer H, Marzi I. The role of angio-embolization in the acute treatment concept of severe pelvic ring injuries. Injury. 2015;46(Suppl 4):S33–8.CrossRefPubMed Lustenberger T, Wutzler S, Stormann P, Laurer H, Marzi I. The role of angio-embolization in the acute treatment concept of severe pelvic ring injuries. Injury. 2015;46(Suppl 4):S33–8.CrossRefPubMed
10.
go back to reference Travis T, Monsky WL, London J, Danielson M, Brock J, Wegelin J, et al. Evaluation of short-term and long-term complications after emergent internal iliac artery embolization in patients with pelvic trauma. J Vasc Interv Radiol JVIR. 2008;19(6):840–7.CrossRefPubMed Travis T, Monsky WL, London J, Danielson M, Brock J, Wegelin J, et al. Evaluation of short-term and long-term complications after emergent internal iliac artery embolization in patients with pelvic trauma. J Vasc Interv Radiol JVIR. 2008;19(6):840–7.CrossRefPubMed
11.
go back to reference Huittinen VM, Slatis P. Postmortem angiography and dissection of the hypogastric artery in pelvic fractures. Surgery. 1973;73(3):454–62.PubMed Huittinen VM, Slatis P. Postmortem angiography and dissection of the hypogastric artery in pelvic fractures. Surgery. 1973;73(3):454–62.PubMed
12.
go back to reference Kimbrell BJ, Velmahos GC, Chan LS, Demetriades D. Angiographic embolization for pelvic fractures in older patients. Arch Surg. 2004;139(7):728–32 (discussion 32-3).CrossRefPubMed Kimbrell BJ, Velmahos GC, Chan LS, Demetriades D. Angiographic embolization for pelvic fractures in older patients. Arch Surg. 2004;139(7):728–32 (discussion 32-3).CrossRefPubMed
13.
14.
go back to reference Cerva DS Jr, Mirvis SE, Shanmuganathan K, Kelly IM, Pais SO. Detection of bleeding in patients with major pelvic fractures: value of contrast-enhanced CT. AJR Am J Roentgenol. 1996;166(1):131–5.CrossRefPubMed Cerva DS Jr, Mirvis SE, Shanmuganathan K, Kelly IM, Pais SO. Detection of bleeding in patients with major pelvic fractures: value of contrast-enhanced CT. AJR Am J Roentgenol. 1996;166(1):131–5.CrossRefPubMed
15.
go back to reference Bozeman MC, Cannon RM, Trombold JM, Smith JW, Franklin GA, Miller FB, et al. Use of computed tomography findings and contrast extravasation in predicting the need for embolization with pelvic fractures. Am Surg. 2012;78(8):825–30.PubMed Bozeman MC, Cannon RM, Trombold JM, Smith JW, Franklin GA, Miller FB, et al. Use of computed tomography findings and contrast extravasation in predicting the need for embolization with pelvic fractures. Am Surg. 2012;78(8):825–30.PubMed
16.
go back to reference Kuo LW, Yang SJ, Fu CY, Liao CH, Wang SY, Wu SC. Relative hypotension increases the probability of the need for angioembolisation in pelvic fracture patients without contrast extravasation on computed tomography scan. Injury. 2016;47(1):37–42.CrossRefPubMed Kuo LW, Yang SJ, Fu CY, Liao CH, Wang SY, Wu SC. Relative hypotension increases the probability of the need for angioembolisation in pelvic fracture patients without contrast extravasation on computed tomography scan. Injury. 2016;47(1):37–42.CrossRefPubMed
17.
go back to reference Uyeda J, Anderson SW, Kertesz J, Soto JA. Pelvic CT angiography: application to blunt trauma using 64MDCT. Emerg Radiol. 2010;17(2):131–7.CrossRefPubMed Uyeda J, Anderson SW, Kertesz J, Soto JA. Pelvic CT angiography: application to blunt trauma using 64MDCT. Emerg Radiol. 2010;17(2):131–7.CrossRefPubMed
18.
go back to reference Boscak AR, Shanmuganathan K, Mirvis SE, Fleiter TR, Miller LA, Sliker CW, et al. Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans. Radiology. 2013;268(1):79–88.CrossRefPubMed Boscak AR, Shanmuganathan K, Mirvis SE, Fleiter TR, Miller LA, Sliker CW, et al. Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans. Radiology. 2013;268(1):79–88.CrossRefPubMed
19.
go back to reference Bae KT. Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology. 2010;256(1):32–61.CrossRefPubMed Bae KT. Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology. 2010;256(1):32–61.CrossRefPubMed
21.
go back to reference Wong YC, Wang LJ, Ng CJ, Tseng IC, See LC. Mortality after successful transcatheter arterial embolization in patients with unstable pelvic fractures: rate of blood transfusion as a predictive factor. J Trauma. 2000;49(1):71–5.CrossRefPubMed Wong YC, Wang LJ, Ng CJ, Tseng IC, See LC. Mortality after successful transcatheter arterial embolization in patients with unstable pelvic fractures: rate of blood transfusion as a predictive factor. J Trauma. 2000;49(1):71–5.CrossRefPubMed
22.
go back to reference Floccard B, Rugeri L, Faure A, Saint Denis M, Boyle EM, Peguet O, et al. Early coagulopathy in trauma patients: an on-scene and hospital admission study. Injury. 2012;43(1):26–32.CrossRefPubMed Floccard B, Rugeri L, Faure A, Saint Denis M, Boyle EM, Peguet O, et al. Early coagulopathy in trauma patients: an on-scene and hospital admission study. Injury. 2012;43(1):26–32.CrossRefPubMed
23.
24.
go back to reference Panetta T, Sclafani SJ, Goldstein AS, Phillips TF, Shaftan GW. Percutaneous transcatheter embolization for massive bleeding from pelvic fractures. J Trauma. 1985;25(11):1021–9.PubMed Panetta T, Sclafani SJ, Goldstein AS, Phillips TF, Shaftan GW. Percutaneous transcatheter embolization for massive bleeding from pelvic fractures. J Trauma. 1985;25(11):1021–9.PubMed
25.
go back to reference Jeroukhimov I, Ashkenazi I, Kessel B, Gaziants V, Peer A, Altshuler A, et al. Selection of patients with severe pelvic fracture for early angiography remains controversial. Scand J Trauma Resusc Emerg Med. 2009;17:62.CrossRefPubMedPubMedCentral Jeroukhimov I, Ashkenazi I, Kessel B, Gaziants V, Peer A, Altshuler A, et al. Selection of patients with severe pelvic fracture for early angiography remains controversial. Scand J Trauma Resusc Emerg Med. 2009;17:62.CrossRefPubMedPubMedCentral
26.
go back to reference Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.CrossRefPubMed Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.CrossRefPubMed
27.
go back to reference Sadro CT, Sandstrom CK, Verma N, Gunn ML. Geriatric trauma: a radiologist’s guide to imaging trauma patients aged 65 years and older. Radiographics. 2015;35(4):1263–85.CrossRefPubMed Sadro CT, Sandstrom CK, Verma N, Gunn ML. Geriatric trauma: a radiologist’s guide to imaging trauma patients aged 65 years and older. Radiographics. 2015;35(4):1263–85.CrossRefPubMed
28.
go back to reference Kowalenko T, Stern S, Dronen S, Wang X. Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic shock in a swine model. J Trauma. 1992;33(3):349–53 (discussion 61-2).CrossRefPubMed Kowalenko T, Stern S, Dronen S, Wang X. Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic shock in a swine model. J Trauma. 1992;33(3):349–53 (discussion 61-2).CrossRefPubMed
Metadata
Title
Predictors of active arterial hemorrhage on angiography in pelvic fracture patients
Authors
Ying-Chieh Lai
Cheng-Hsien Wu
Huan-Wu Chen
Li-Jen Wang
Yon-Cheong Wong
Publication date
01-03-2018
Publisher
Springer Japan
Published in
Japanese Journal of Radiology / Issue 3/2018
Print ISSN: 1867-1071
Electronic ISSN: 1867-108X
DOI
https://doi.org/10.1007/s11604-017-0716-x

Other articles of this Issue 3/2018

Japanese Journal of Radiology 3/2018 Go to the issue

Acknowledgment

Acknowledgment