Abstract
PurposeTo evaluate whether an arterial phase scan improves the diagnostic performance of computed tomography to identify pelvic trauma patients who received angiographic intervention on demand of the trauma surgeon.MethodsThis retrospective single-center study was performed at an academic Scandinavian trauma center with approximately 2000 trauma admissions annually. Pelvic trauma patients with arterial and portal venous phase CT from 2009 to 2015 were included. The patients were identified from the institutional trauma registry. Images were interpreted by two radiologists with more than 10 years of trauma radiology experience. Positive findings for extravasation on portal venous phase alone or on both arterial and portal venous phase were compared, with angiographic intervention as clinical outcome.ResultsOne hundred fifty-seven patients (54 females, 103 males) with a median age of 45 years were enrolled. Sixteen patients received angiographic intervention. Positive CT findings on portal venous phase only had a sensitivity and specificity of 62% and 86%, vs. 56% and 93% for simultaneous findings on arterial and portal venous phase. Specificity was significantly higher for positive findings in both phases compared with portal venous phase only. Applying a threshold > 0.9 cm of extravasation diameter to portal venous phase only resulted in sensitivity and specificity identical to those of both phases.ConclusionArterial phase scan in addition to portal venous phase scan did not improve patient selection for angiography. Portal venous phase extravasation size alone may be used as an imaging-based biomarker of the need for angiographic intervention.
Highlights
Pelvic fractures occur in 4–9.3% of patients with blunt trauma [1, 2]
Exsanguination remains a major challenge in treatment of these patients, with active hemorrhage resulting in a mortality rate of up to 40% [3,4,5]
Computed tomography (CT) is the preferred method to evaluate the need for pelvic angiography in addition to clinical parameters [8, 12, 13], with contrast extravasation (“blush”) being a strong indicator of active pelvic bleeding [14, 15]
Summary
Pelvic fractures occur in 4–9.3% of patients with blunt trauma [1, 2]. With nonoperative management strategies becoming more important in trauma care, angiography with embolization is an accepted therapy for pelvic hemorrhage in hemodynamically stabilized patients [9,10,11]. Computed tomography (CT) is the preferred method to evaluate the need for pelvic angiography in addition to clinical parameters [8, 12, 13], with contrast extravasation (“blush”) being a strong indicator of active pelvic bleeding [14, 15]. According to a recent survey among level 1 trauma centers in the USA, 60% of participants scored contrast extravasation as an indication for angioembolization [16]
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