Prediction of arterial extravasation in pelvic fracture patients with stable hemodynamics using coagulation biomarkers

Makoto Aoki,Kiyohiro Oshima,Mitsunobu Nakamura,Shuichi Hagiwara,Takayuki Ogura

doi:10.1186/s13017-019-0234-5

Makoto Aoki, Kiyohiro Oshima + Show 3 more

Open Access

https://doi.org/10.1186/s13017-019-0234-5

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Abstract

BackgroundDetermining the presence of an active arterial hemorrhage in the acute phase is important as a treatment strategy in patients with pelvic fracture. The purpose of this study was to evaluate whether coagulation biomarkers could predict arterial extravasation, especially in pelvic fracture patients with stable hemodynamics.MethodsWe studied patients with a pelvic fracture who had a systolic blood pressure above 90 mmHg and lactate level less than 5.0 mmol/L on hospital arrival. Patients were divided into two groups: those with arterial extravasation on enhanced computed tomography (CT) or angiography (extravasation [+] group) and those without arterial extravasation (extravasation [−] group). Coagulation biomarkers measured on arrival were statistically compared between the two groups. Predictive ability of arterial extravasation using coagulation biomarkers was evaluated by receiver-operating characteristic analyses provided area under the receiver-operating characteristic curves (AUROC) and diagnostic indicators with optimal cutoff point including sensitivity, specificity, positive and negative predictive values, and diagnostic odds ratio (DOR).ResultsSixty patients were analyzed. Fibrin degradation products (FDP), D-dimer, prothrombin time–international normalized ratio (PT–INR), and the ratio of FDP to fibrinogen were significantly higher in the extravasation (+) group than in the extravasation (−) group (FDP, 242 μg/mL [145–355] vs. 96 μg/mL [58–153]; D-dimer, 81 μg/mL [41–140] vs. 39 μg/mL [21–75]; PT–INR, 1.09 [1.05–1.24] vs. 1.02 [0.98–1.08]; and ratio of FDP to fibrinogen, 1.06 [0.85–2.01] vs. 0.46 [0.25–0.74]). The highest AUROC was with a ratio of FDP to fibrinogen of 0.777 (95% confidence interval, 0.656–0.898), and the highest predictive ability in terms of DOR was with a ratio of FDP to fibrinogen (sensitivity, 0.76; specificity, 0.76; DOR 9.90).ConclusionCoagulation biomarker could predict of arterial extravasation in pelvic fracture patients with stable hemodynamics.

Highlights

Determining the presence of an active arterial hemorrhage in the acute phase is important as a treatment strategy in patients with pelvic fracture
Forty-nine patients with abbreviated injury scale (AIS) scores that were greater in another region than the pelvis, three patients with an arterial extravasation in a non-pelvic region, one patient with an unknown time of trauma occurrence, and 44 patients with unstable hemodynamics were excluded
Brief summary This study demonstrated the association of arterial extravasation in pelvic fracture patients with stable hemodynamics and coagulation biomarkers

Summary

Introduction

Determining the presence of an active arterial hemorrhage in the acute phase is important as a treatment strategy in patients with pelvic fracture. Pelvic fracture has been shown to be an independent risk factor for death after blunt trauma [1, 2]. It is associated with increased mortality in the blunt trauma population. In the acute phase of a pelvic fracture, arterial hemorrhage occurs from 3 to 20% of patients and induces hemodynamic instability [3,4,5]. The exact evaluation of arterial extravasation has differed between readers, which made the interpretation of contrast-enhanced CT more difficult

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