1
|
Fokin AA, Wycech Knight J, Tharp ME, Brinton KC, Gallagher PK, Xie JF, Weisz RD, Puente I. Pelvic fractures in blunt trauma patients: A comparative study. World J Orthop 2024; 15:418-434. [PMID: 38835686 PMCID: PMC11145966 DOI: 10.5312/wjo.v15.i5.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/09/2024] [Accepted: 04/23/2024] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND Pelvic fractures (PF) with concomitant injuries are on the rise due to an increase of high-energy trauma. Increase of the elderly population with age related comorbidities further complicates the management. Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones. Presence of contrast blush (CB) on computed tomography in patients with PF is considered a sign of active bleeding, however, its clinical significance and association with outcomes is debatable. AIM To analyze polytrauma patients with PF with a focus on the geriatric population, co-injuries and the value of contrast blush. METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center (01/2017-01/2023). Analyzed variables included: Age, sex, mechanism of injury (MOI), injury severity score (ISS), Glasgow coma scale (GCS), abbreviated injury scale (AIS), co-injuries, transfusion requirements, pelvic angiography, embolization, laparotomy, orthopedic pelvic surgery, intensive care unit and hospital lengths of stay, discharge disposition and mortality. The study compared geriatric and non-geriatric patients, patients with and without CB and abdominal co-injuries. Propensity score matching was implemented in comparison groups. RESULTS PF comprised 4% of all trauma admissions. 89 patients had CB. 286 (52%) patients had concomitant injuries including 93 (17%) patients with abdominal co-injuries. Geriatric patients compared to non-geriatric had more falls as MOI, lower ISS and AIS pelvis, higher GCS, less abdominal co-injuries, similar CB and angio-embolization rates, less orthopedic pelvic surgeries, shorter lengths of stay and higher mortality. After propensity matching, orthopedic pelvic surgery rates remained lower (8% vs 19%, P < 0.001), hospital length of stay shorter, and mortality higher (13% vs 4%, P < 0.001) in geriatric patients. Out of 89 patients with CB, 45 (51%) were embolized. After propensity matching, patients with CB compared to without CB had more pelvic angiography (71% vs 12%, P < 0.001), higher embolization rates (64% vs 22%, P = 0.02) and comparable mortality. CONCLUSION Half of the patients with PF had concomitant co-injuries, including abdominal co-injuries in 17%. Similarly injured geriatric patients had higher mortality. Half of the patients with CB required an embolization.
Collapse
Affiliation(s)
- Alexander A Fokin
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Charles E Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Joanna Wycech Knight
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Trauma and Critical Care Services, Broward Health Medical Center, Fort Lauderdale, FL 33316, United States
| | - Madison E Tharp
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Kyler C Brinton
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Phoebe K Gallagher
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Justin Fengyuan Xie
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Russell D Weisz
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
| | - Ivan Puente
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Charles E Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, Boca Raton, FL 33431, United States
- Trauma and Critical Care Services, Broward Health Medical Center, Fort Lauderdale, FL 33316, United States
- Herbert Wertheim College of Medicine, Department of Surgery, Florida International University, Miami, FL 33199, United States
| |
Collapse
|
2
|
Viswanathan A, Na HY, Breckenridge L, Muller A, Butts C, Reilly E, Geng T, Sigal A, Michels R, Ong A. Hypotension in the Emergency Department and Contrast Extravasation on Computerized Tomography Predict Blood Transfusion in Low-Energy Pelvic Fractures. J Surg Res 2024; 296:310-315. [PMID: 38306936 DOI: 10.1016/j.jss.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/29/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Although low-energy pelvic fractures seldom present with significant hemorrhage, early recognition of at-risk patients is essential. We aimed to identify predictors of transfusion requirements in this cohort. METHODS A 7-y retrospective chart review was performed. Low-energy mechanism was defined as falls of ≤5 feet. Fracture pattern was classified using the Orthopedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen system as A, B, or C. Primary outcome was transfusion of ≥2 units of packed red blood cells in the first 48 h. Univariable analysis and logistic regression analysis were performed. A P value ≤0.05 was considered significant. RESULTS Five hundred forty six patients were included with median (interquartile range) age of 86 (79-91) and median (interquartile range) Injury Severity Score of 5 (4-8). Five hundred forty one (99%) had type A fractures. Twenty six (5%) had the primary outcome and 17 (3%) died. Logistic regression found that systolic blood pressure <100 mmHg at any time in the Emergency Department, Injury Severity Score, and pelvic angiography were predictors of the primary outcome. Seventeen percent of those who had the primary outcome died compared with 2% who did not (P = 0.0004). Three hundred sixty four (67%) received intravenous contrast for computerized tomography scans and of these, 44 (12%) had contrast extravasation (CE). CE was associated with the primary outcome but not mortality. CONCLUSIONS Hypotension at any time in the Emergency Department and CE on computerized tomography predicted transfusion of ≥2 units packed red blood cells in the first 48 h in patients with low-energy pelvic fractures.
Collapse
Affiliation(s)
| | - Hee Yun Na
- Drexel University College of Medicine, Wyomissing, Pennsylvania
| | - Leigham Breckenridge
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Alison Muller
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Christopher Butts
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Eugene Reilly
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Thomas Geng
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Adam Sigal
- Department of Emergency Medicine, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Ryan Michels
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Adrian Ong
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania.
| |
Collapse
|
3
|
Giurazza F, Pane F, Roccatagliata P, Casciano E, Corvino F, Festa P, Ponticiello G, Cappabianca S, Romano L, Niola R. Pelvic ring fractures with concomitant large hematomas: diagnostic investigation with arteriography and eventual embolization in 157 trauma patients, with or without contrast extravasation at emergency CT. LA RADIOLOGIA MEDICA 2023; 128:1429-1439. [PMID: 37715849 DOI: 10.1007/s11547-023-01714-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/25/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE This study aims to evaluate the diagnostic value of pelvic arteriography in patients with pelvic ring fractures and associated large hematomas, in both cases of positive or negative findings of contrast agent extravasation at emergency CT; in those patients with positive DSA subsequently treated with embolization, correlations with clinical-radiological parameters were investigated. MATERIALS AND METHODS In this single-center retrospective study, patients with acute blunt pelvic trauma showing at CT pelvic ring fractures with associated large (> 3 cm) hematoma, with or without signs of arterial bleeding, were investigated with DSA. Technical success was considered radiographic bleeding control with disappearance of angiographic bleeding; clinical success was defined as clinical bleeding control hemodynamically stable, before applying other surgical maneuvers. Pelvic ring fractures were evaluated according to Tile classification system. RESULTS One hundred and fifty-seven patients, mean age 54years, were analyzed. 70.7% had polytrauma; 14.6% patients assumed antiplatelets and/or anticoagulation therapy. False-negative and false-positive rates at CT were 29.6% and 27.1%, respectively. Polytrauma and B3/C1 Tile pattern fractures were significantly associated with bleeding signs at DSA. Seventy-two patients required embolization: 52.8% showed direct signs of DSA bleeding; among these, technical and clinical successes were 88.8% and 81.9%, respectively. CONCLUSIONS In this study, patients with pelvic ring fractures and concomitant hematomas > 3 cm, with or without contrast extravasation at CT, have been examined in depth with DSA focusing on both direct and indirect angiographic signs of bleeding, finding polytrauma and Tile fracture patterns B3/C1 predictive factors for arterial hemorrhage detection at DSA despite negative CT findings.
Collapse
Affiliation(s)
- Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, Naples, 80131, Italy.
| | - Francesco Pane
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, Naples, 80131, Italy
| | - Pietro Roccatagliata
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, 80138, Italy
| | - Eduardo Casciano
- Orthopedic and Trauma Unit, Department of Surgery, Cardarelli Hospital, Via Antonio Cardarelli 9, Naples, 80131, Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, Naples, 80131, Italy
| | - Patrizio Festa
- Trauma Center Department, Cardarelli Hospital, Via Antonio Cardarelli 9, Naples, 80131, Italy
| | - Gianluca Ponticiello
- Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, 80138, Italy
| | - Luigia Romano
- Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
| | - Raffaella Niola
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, Naples, 80131, Italy
| |
Collapse
|
4
|
Ramsey WA, O'Neil CF, Ramdev RA, Sleeman EA, Danton GH, Kaufman JI, Pizano LR, Meizoso JP, Proctor KG, Namias N. Illuminating the Use of Trauma Whole-Body CT Scan During the Global Contrast Shortage. J Am Coll Surg 2023; 236:937-942. [PMID: 36728386 DOI: 10.1097/xcs.0000000000000551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Use of whole-body CT scan (WBCT) is widespread in the evaluation of traumatically injured patients and may be associated with improved survival. WBCT protocols include the use of IV contrast unless there is a contraindication. This study tests the hypothesis that using plain WBCT scan during the global contrast shortage would result in greater need for repeat contrast-enhanced CT, but would not impact mortality, missed injuries, or rates of acute kidney injury (AKI). STUDY DESIGN All trauma encounters at an academic level-I trauma center between March 1, 2022 and June 24, 2022, excluding burns and prehospital cardiac arrests, were reviewed. Imaging practices and outcomes before and during contrast shortage (beginning May 3, 2022) were compared. RESULTS The study population included 1,109 consecutive patients (72% male), with 890 (80%) blunt and 219 (20%) penetrating traumas. Overall, 53% of patients underwent WBCT and contrast was administered to 73%. The overall rate of AKI was 6% and the rate of renal replacement therapy (RRT) was 1%. Contrast usage in WBCT was 99% before and 40% during the shortage (p < 0.001). There was no difference in the rate of repeat CT scans, missed injuries, AKI, RRT, or mortality. CONCLUSIONS Trauma imaging practices at our center changed during the global contrast shortage; the use of contrast decreased despite the frequency of trauma WBCT scans remaining the same. The rates of AKI and RRT did not change, suggesting that WBCT with contrast is insufficient to cause AKI. The missed injury rate was equivalent. Our data suggest similar outcomes can be achieved with selective IV contrast use during WBCT.
Collapse
Affiliation(s)
- Walter A Ramsey
- From the DeWitt Daughtry Family Department of Surgery (Ramsey, O'Neil, Kaufman, Pizano, Meizoso, Proctor, Namias), Miami, FL
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL (Ramsey, O'Neil, Danton, Kaufman, Pizano, Meizoso, Proctor, Namias)
| | - Christopher F O'Neil
- From the DeWitt Daughtry Family Department of Surgery (Ramsey, O'Neil, Kaufman, Pizano, Meizoso, Proctor, Namias), Miami, FL
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL (Ramsey, O'Neil, Danton, Kaufman, Pizano, Meizoso, Proctor, Namias)
| | - Rajan A Ramdev
- University of Miami Miller School of Medicine (Ramdev, Sleeman), Miami, FL
| | - Ella A Sleeman
- University of Miami Miller School of Medicine (Ramdev, Sleeman), Miami, FL
| | - Gary H Danton
- Department of Radiology (Danton), Miami, FL
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL (Ramsey, O'Neil, Danton, Kaufman, Pizano, Meizoso, Proctor, Namias)
| | - Joyce I Kaufman
- From the DeWitt Daughtry Family Department of Surgery (Ramsey, O'Neil, Kaufman, Pizano, Meizoso, Proctor, Namias), Miami, FL
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL (Ramsey, O'Neil, Danton, Kaufman, Pizano, Meizoso, Proctor, Namias)
| | - Louis R Pizano
- From the DeWitt Daughtry Family Department of Surgery (Ramsey, O'Neil, Kaufman, Pizano, Meizoso, Proctor, Namias), Miami, FL
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL (Ramsey, O'Neil, Danton, Kaufman, Pizano, Meizoso, Proctor, Namias)
| | - Jonathan P Meizoso
- From the DeWitt Daughtry Family Department of Surgery (Ramsey, O'Neil, Kaufman, Pizano, Meizoso, Proctor, Namias), Miami, FL
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL (Ramsey, O'Neil, Danton, Kaufman, Pizano, Meizoso, Proctor, Namias)
| | - Kenneth G Proctor
- From the DeWitt Daughtry Family Department of Surgery (Ramsey, O'Neil, Kaufman, Pizano, Meizoso, Proctor, Namias), Miami, FL
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL (Ramsey, O'Neil, Danton, Kaufman, Pizano, Meizoso, Proctor, Namias)
| | - Nicholas Namias
- From the DeWitt Daughtry Family Department of Surgery (Ramsey, O'Neil, Kaufman, Pizano, Meizoso, Proctor, Namias), Miami, FL
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL (Ramsey, O'Neil, Danton, Kaufman, Pizano, Meizoso, Proctor, Namias)
| |
Collapse
|
5
|
Kawinwongkowit K, Kaewlai R, Kasemassawachanont A, Chatpuwaphat J, Kumthong N, Somcharit L. Value of contrast-enhanced arterial phase imaging in addition to portovenous phase in CT evaluation of blunt abdominopelvic trauma. Eur Radiol 2023; 33:1641-1652. [PMID: 36322194 DOI: 10.1007/s00330-022-09208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/25/2022] [Accepted: 09/30/2022] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Compare the diagnostic performance of the arterial phase plus portovenous phases (AP + PVP) of abdominopelvic CT (CT) with PVP alone in the detection and characterization of traumatic vascular injury and the effects on radiologists' confidence. METHODS CT of 103 consecutive inpatients (median 36 years, 83 males) with blunt abdominopelvic injuries were retrospectively included if performed within 24 h after trauma and before definitive management. Images were re-reviewed by two blinded radiologists with disagreements resolved by the third radiologist. RESULTS Sixty vascular injuries (liver 23, spleen 15, kidneys 9, pancreas 2, adrenals 3, mesentery, and pelvis 4 each) were found with 4 injuries (liver 2, spleen, and kidneys 1 each) not detected at initial CT. Nineteen (liver 6, spleen 10, kidneys 2, adrenal 1) were visualized only on AP. The sensitivity and accuracy of AP + PVP were 89.58-91.67% and 94.44-95.15%, compared to 61.67-62.50% and 77.67-80.00% of PVP alone. The agreements on the types of injury with final diagnoses were higher for AP + PVP than for PVP alone (78.69% vs. 44.26%). The mean diagnostic radiologist confidence ((1 = 25%, 2 = 50%, 3 = 75%, 4 > 90%) increased significantly in the detection (from 3.38 to 3.71) and characterization (from 2.46 to 3.67) of vascular injuries with AP + PVP compared to PVP alone. For 19 lesions detected only on AP, 11 (spleen 8, liver 2, adrenal 1) received nonoperative management; others had transarterial embolization or surgery. CONCLUSIONS The addition of AP improves the detection and characterization of vascular injuries in CT evaluation of blunt abdominopelvic trauma. KEY POINTS • AP+PVP was more sensitive and precise than PVP alone in the detection of traumatic vascular abdominopelvic injuries. • AP+PVP improved the characterization of traumatic abdominopelvic vascular injuries. • When all abdominopelvic vascular injuries were considered, AP increased radiologists' diagnostic confidence in the detection and characterization of vascular injuries.
Collapse
Affiliation(s)
- Kawin Kawinwongkowit
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Rathachai Kaewlai
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand.
| | - Adisak Kasemassawachanont
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Jitti Chatpuwaphat
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Nutnaree Kumthong
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| | - Lertpong Somcharit
- Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkok Noi, Bangkok, 10700, Thailand
| |
Collapse
|
6
|
Huang JG, Zhang ZY, Li L, Liu GB, Li X. Multi-slice spiral computed tomography in diagnosing unstable pelvic fractures in elderly and effect of less invasive stabilization. World J Clin Cases 2022; 10:4470-4479. [PMID: 35663060 PMCID: PMC9125281 DOI: 10.12998/wjcc.v10.i14.4470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/17/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Older people are more likely to experience pelvic fractures than younger people. Multi-slice spiral computed tomography (CT) uses three-dimensional (3D) reconstruction technology to generate 3D images that can clearly demonstrate the 3D space of fractures and detect fractures at a higher rate. AIM To investigate the clinical value of multi-slice spiral CT 3D reconstruction in the diagnosis of unstable pelvic fractures in the elderly as well as the effect of less invasive stabilization. METHODS A total of 86 patients with unstable pelvic fractures treated between March 2016 and March 2019 underwent femoral supracondylar bone traction before surgery. Pelvic radiography and multi-row spiral CT were performed successively once the patient's vital signs and hemodynamic indices were stable. Secondary processing of the original data was performed to obtain 3D reconstruction images and determine the vertical displacement of the pelvis. After basic or complete reduction, minimally invasive internal fixation using hollow lag screws was performed. The detection rates of fracture location and classification by X-ray and CT reconstruction were compared. Patients were divided into two groups according to the presence or absence of preoperative 3D reconstruction to compare postoperative reduction, wound healing time, fracture healing time, hospitalization time, visual analog scale (VAS) score, poor internal fixation, and functional recovery. RESULTS The diagnostic coincidence rates of X-rays for pubic symphysis, ilium wing, sacroiliac periarticular, and sacral fractures were lower than those of CT reconstruction. The coincidence rate of CT reconstruction in the clinical classification of pelvic fractures was 100%, whereas 11 cases were misdiagnosed by X-ray; the total coincidence rate was 87.21%. The total excellent and good rates of postoperative reduction were significantly higher in the study group than in the control group (P < 0.05). The wound healing, fracture healing, and hospitalization times were significantly shorter in the study group than in the control group (P < 0.05). The VAS scores decreased in both groups postoperatively and were lower in the study group than in the control group (P < 0.05). The total incidence of poor postoperative internal fixation was significantly lower in the study group than in the control group (P < 0.05). The overall rate of postoperative functional recovery was significantly higher in the study group than in the control group (P < 0.05). CONCLUSION Multi-slice spiral CT has high guiding significance for the diagnosis, classification, and treatment of unstable pelvic fractures in the elderly. Preoperative 3D reconstruction can effectively shorten the operation time and promote fracture healing, while minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites, making it worthy of clinical application.
Collapse
Affiliation(s)
- Jian-Guo Huang
- Department of Orthopedics, Sanya Hospital of Traditional Chinese Medicine, Sanya 572000, Hainan Province, China
| | - Zhi-Yuan Zhang
- Department of Orthopedics, Sanya Hospital of Traditional Chinese Medicine, Sanya 572000, Hainan Province, China
| | - Liang Li
- Department of Orthopedics, Xi’an Honghui Hospital, Xi’an 710024, Shaanxi Province, China
| | - Guang-Bao Liu
- Department of Radiology, Sanya Hospital of Traditional Chinese Medicine, Sanya 572000, Hainan Province, China
| | - Xiong Li
- Department of Traumatic Orthopedics Sports Medicine, Yan’an Hospital of Traditional Chinese Medicine, Yan’an 716000, Shaanxi Province, China
| |
Collapse
|
7
|
Nakajima K, Yamaguchi K, Abe T, Taniguchi H, Mizukami S, Sekikawa Z, Takeuchi I. Extravasation and outcomes in computed tomography and angiography in patients with pelvic fractures requiring transcatheter arterial embolization: A single-center observational study. J Trauma Acute Care Surg 2022; 92:873-879. [PMID: 34711794 DOI: 10.1097/ta.0000000000003446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extravasation on contrast-enhanced computed tomography (CECT) is a helpful indicator of the need for transcatheter arterial embolization (TAE) for pelvic fractures. However, previous reports were inconsistent on cases in which angiography is necessary, even though there is no extravasation on computed tomography. This study aimed to describe and analyze the contradictory findings in cases where extravasation is observed on angiography but not on CECT, to contribute to improved management of patients with pelvic fractures. METHODS This was a retrospective single-center study. Patients with pelvic fractures who underwent CECT and TAE between 2014 and 2020 were included. We classified the patients into three groups: CECT and angiography with extravasation (CT+Angio+), CECT with no extravasation and angiography with extravasation (CT-Angio+), and CECT with extravasation and angiography without extravasation (CT+Angio-). RESULTS A total of 113 patients were included in the study: the CT+Angio+ group had 54 patients, CT-Angio+ group, 47; and CT+Angio- group, 12. The CT-Angio+ group had a significantly longer time from arrival to CECT than the CT+Angio+ group (27 minutes vs. 23 minutes, p < 0.05). The CT-Angio+ group had significantly more blood transfusions (fresh frozen plasma, platelets) within 24 hours than the CT+Angio- group did (p < 0.05), and ventilator management days (p < 0.05) and intensive care unit stays (p < 0.05) were significantly longer. CONCLUSION There was no significant difference in outcomes among the three groups. There was no difference in severity, transfusion volume, or mortality in patients with pelvic fractures needing TAE, classified as CT-Angio+, compared with that of CT+Angio+ patients. Even in the absence of extravasation in the pelvic region on CECT, angiography or TAE may still be necessary. LEVEL OF EVIDENCE Therapeutic/Care Management, Level IV.
Collapse
Affiliation(s)
- Kento Nakajima
- From the Department of Radiology (K.N.), Yokosuka Kyosai Hospital; Department of Emergency Medicine (K.N., K.Y., T.A., H.T., S.M., I.T.), Graduate School of Medicine, Yokohama City University; and Advanced Critical Care and Emergency Center (T.A., H.T., I.T.) and Department of Radiology (Z.S.), Yokohama City University Medical Center, Kanagawa, Japan
| | | | | | | | | | | | | |
Collapse
|
8
|
The accuracy of contrast-enhanced computed tomography scans to detect postpartum haemorrhage: an observational study. BMC Pregnancy Childbirth 2022; 22:67. [PMID: 35078417 PMCID: PMC8788069 DOI: 10.1186/s12884-021-04306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 11/25/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Postpartum haemorrhage is a major cause of maternal mortality. Although contrast-enhanced computed tomography (CE-CT) is useful to reveal arterial bleeding, its accuracy in postpartum haemorrhage is unclear. The aim of this study was to evaluate the accuracy of CE-CT scanning in detecting postpartum haemorrhage. METHODS This was a retrospective observational study. We included patients with postpartum haemorrhage treated by emergency physicians in collaboration with obstetricians. We calculated the sensitivity, specificity, and positive and negative predictive values for CE-CT scanning to detect arterial bleeding. RESULTS CE-CT scanning was performed in 52 patients, and 31 patients had extravasation. The sensitivity of CE-CT scanning to detect arterial extravasation was 100% (15/15), specificity was 28.6% (2/7), positive predictive value was 75% (15/20), and negative predictive value was 100% (2/2). CONCLUSION We showed the sensitivity of CE-CT scanning to detect arterial extravasation in patients with postpartum haemorrhage to be 100%.
Collapse
|
9
|
Kuo LW, Wang CY, Liao CA, Wu YT, Liao CH, Hsieh CH, Fu CY. Is It Beneficial to Optimize Vital Signs Before Embolization for Pelvic Fractures? A Dilemma Between Resuscitation and Hemostasis. Am Surg 2022:31348211065119. [DOI: 10.1177/00031348211065119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose Adequate resuscitation and definitive hemostasis are both important in the management of hemorrhage related to pelvic fracture. The goal of this study was to analyze the relationship between the amount of blood transfused before transcatheter arterial embolization (TAE) and the clinical outcome later in the disease course. Methods Patients with pelvic fractures who underwent TAE for hemostasis from January 2018 to December 2019 were studied. The characteristics of patients who received blood transfusions of >2 U (1000 mL) and ≤2 U before TAE were compared. The mortality rate, blood transfusion-related complications, and length of stay were compared between these two groups. Results Among the 75 studied patients, 39 (52.0%) received blood transfusions of ≤2 U before TAE, and the other 36 (48.0%) patients received blood transfusions of >2 U before TAE. The incidence rates of systemic inflammatory response syndrome, sepsis, and coagulopathy were significantly higher in the >2 U group (97.2% vs 81.1%, P = .027; 50.0% vs 27.0%, P = .045; and 44.4% vs 5.4%, P < .01, respectively). After nonsurvivors were excluded, the >2 U group had a significantly higher proportion (43.8% vs 14.7%, P < .001) of prolonged intensive care unit (ICU) length of stay (7 days or more) and a longer hospital length of stay (33.8 ± 15.1 vs 21.9 ± 94.0, P < .01) than the ≤2 U group. Pre-TAE blood transfusion >2 U serves as an independent risk factor for prolonged ICU length of stay and increased hospital length of stay. Conclusion Early hemostasis for pelvic fracture-related hemorrhage is suggested to prevent pre-TAE blood transfusion-associated adverse effects of blood transfusion.
Collapse
Affiliation(s)
- Ling-Wei Kuo
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Yu Wang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chien-An Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Tung Wu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
10
|
Dreizin D, Rosales R, Li G, Syed H, Chen R. Volumetric Markers of Body Composition May Improve Personalized Prediction of Major Arterial Bleeding After Pelvic Fracture: A Secondary Analysis of the Baltimore CT Prediction Model Cohort. Can Assoc Radiol J 2021; 72:854-861. [PMID: 32910695 PMCID: PMC8011455 DOI: 10.1177/0846537120952508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
METHODS This work is a retrospective secondary analysis of a single institution cohort used in the development of the Baltimore CT prediction model. The cohort includes 115 consecutive patients that underwent admission contrast-enhanced CT of the abdomen and pelvis for blunt trauma with pelvic ring disruption followed by conventional angiography. Major arterial injury requiring angioembolization served as the outcome variable. Angioembolization was required in 73/115 patients (63% of the cohort). Average age was 46.9 years (±SD 20.4). Body composition measurements were determined as 2-dimensional (2D) or 3-dimensional (3D) parameters and included mid-L3 trabecular bone attenuation, abdominal visceral fat area or volume, and percent muscle fat fraction (as a marker of sarcopenia) measured using segmentation and histogram analysis. RESULTS Models incorporating 2D (Model B) or 3D markers (model C) of body composition showed improvement over the original Baltimore model (model A) in all parameters of performance, quality, and fit (area under the receiver-operating curve [AUC], Akaike information criterion, Brier score, Hosmer-Lemeshow test, and adjusted-R2). Area under the receiver-operating curve increased from 0.83 (A), to 0.86 (B), and 0.88 (C). The greatest improvement was seen with 3D parameters. CONCLUSION Once automated, quantitative visualization tools providing "free" 3D body composition information can be expected to improve personalized precision diagnostics, outcome prediction, and decision support in patients with bleeding pelvic fractures.
Collapse
Affiliation(s)
- David Dreizin
- Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Remberto Rosales
- Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Guang Li
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hassan Syed
- Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rong Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
11
|
Moon SN, Pyo JS, Kang WS. Accuracy of Contrast Extravasation on Computed Tomography for Diagnosing Severe Pelvic Hemorrhage in Pelvic Trauma Patients: A Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:63. [PMID: 33445551 PMCID: PMC7827356 DOI: 10.3390/medicina57010063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/09/2021] [Accepted: 01/10/2021] [Indexed: 02/01/2023]
Abstract
Background and objective: The early detection of underlying hemorrhage of pelvic trauma has been a critical issue. The aim of this study was to systematically determine the diagnostic accuracy of computed tomography (CT) for detecting severe pelvic hemorrhage. Materials and Methods: Relevant articles were obtained by searching PubMed, EMBASE, and Cochrane databases through 28 November 2020. Diagnostic test accuracy results were reviewed to obtain the sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve of CT for the diagnosis in pelvic trauma patients. The positive finding on CT was defined as the contrast extravasation. As the reference standard, severe pelvic hemorrhage was defined as an identification of bleeding at angiography or by direct inspection using laparotomy that required hemostasis by angioembolization or surgery. A subgroup analysis was performed according to the CT modality that is divided by the number of detector rows. Result: Thirteen eligible studies (29 subsets) were included in the present meta-analysis. Pooled sensitivity of CT was 0.786 [95% confidence interval (CI), 0.574-0.909], and pooled specificity was 0.944 (95% CI, 0.900-0.970). Pooled sensitivity of the 1-4 detector row group and 16-64 detector row group was 0.487 (95% CI, 0.215-0.767) and 0.915 (95% CI, 0.848-0.953), respectively. Pooled specificity of the 1-4 and 16-64 detector row groups was 0.956 (95% CI, 0.876-0.985) and 0.906 (95% CI, 0.828-0.951), respectively. Conclusion: Multi-detector CT with 16 or more detector rows has acceptable high sensitivity and specificity. Extravasation on CT indicates severe hemorrhage in patients with pelvic trauma.
Collapse
Affiliation(s)
- Sung Nam Moon
- Department of Radiology, Wonkwang University Hospital, Iksan 54538, Korea;
| | - Jung-Soo Pyo
- Department of Pathology, Eulji University School of Medicine, Uijeongbu Eulji University, Kyeonggi-do 11759, Korea;
| | - Wu Seong Kang
- Department of Trauma Surgery, Wonkwang University School of Medicine, Wonkwang University Hospital, Iksan 54538, Korea
| |
Collapse
|