Abdominopelvic bleed rate on admission CT correlates with mortality and transfusion needs in the setting of blunt pelvic fractures: a single institution pilot study.

Abstract

The objectives of this study were to calculate the total volumetric rate of abdominopelvic bleeding in patients with acute pelvic fractures and examine the relationships between the bleeding rate, patient outcomes, and required patient interventions. This was a retrospective cohort study which included 29 patients from a 4-year period (May 2013 to May 2017). Patients with acute pelvic fractures and active bleeding detected on CT with two phases of imaging were included. Software was used to measure the volume of active bleeding on arterial and parenchymal phases. The active bleeding rate was calculated by dividing the change in active bleeding volume by the time between the two phases. The total volumetric bleed rate from all sites was then computed. Clinical variables were compared between survivors and non-survivors. Overall mortality in this cohort was 21% (n = 6). The mean abdominopelvic volumetric bleed rate in non-survivors was much greater than survivors (40.7cc/min vs. 5.7cc/min; p < 0.01). Ninety-six percent of survivors had an abdominopelvic bleed rate < 20cc/min compared to 33% of non-survivors. An abdominopelvic bleed rate > 20cc/min was associated with a mortality rate of 80% while a rate of < 20cc/min was associated with a 92% survival rate. The mean pelvic hematoma volume was greater in non-survivors compared to survivors (1854cc vs. 746cc; p < 0.01). There was a positive association between hematoma volume and units of blood transfused (rs = 0.4, n = 29, p = 0.04). An abdominopelvic bleeding rate > 20cc/min was associated with a high risk of mortality.