Faculty Collaboration Database

Clinical significance of computed tomography contrast extravasation in blunt trauma patients with a pelvic fracture. J Trauma Acute Care Surg 2017 Jan;82(1):138-140

Date

10/26/2016

Pubmed ID

27779598

DOI

10.1097/TA.0000000000001305

Scopus ID

2-s2.0-84992371725 (requires institutional sign-in at Scopus site)   32 Citations

Abstract

INTRODUCTION: Blunt pelvic fractures can be associated with major pelvic bleeding. The significance of contrast extravasation (CE) on computed tomography (CT) is debated. We sought to update our experience with CE on CT scan for the years 2009-2014 to determine the accuracy of CE in predicting the need for angioembolization.

METHODS: This is a retrospective review of the trauma registry and our electronic medical record from a Level I trauma center. Patients seen from July 1, 2009, to September 7, 2014, with blunt pelvic fractures and contrast-enhanced CT were included. Standard demographic, clinical, and injury data were obtained. Patient records were queried for CE, performance of angiography, and angioembolization. Positive patients were those where CE was associated with active bleeding requiring angioembolization. All other patients were considered negative.

RESULTS: There were 497 patients during the study time period with blunt pelvic fracture meeting inclusion criteria, and 75 patients (15%) had CE. Of those patients with CE, 30 patients (40%) underwent angiography, and 17 patients (23%) required angioembolization. The sensitivity, specificity, positive predictive value, and negative predictive value of CE on CT were 100%, 87.9%, 22.7%, and 100%, respectively. Two patients without CE underwent angiography but did not undergo embolization. Patients with CE had higher mortality (13 vs. 6%, p < 0.05) despite not having higher ISS scores.

CONCLUSIONS: This study reinforces that CE on CT pelvis with blunt trauma is common, but many patients will not require angioembolization. The negative predictive value of 100% should be reassuring to trauma surgeons such that if a modern CT scanner is used, and there is no CE seen on CT, then the pelvis will not be a source of hemorrhagic shock. All of these findings are likely due to both increased comfort with observing CEs and the increased sensitivity of modern CT scanners.

LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.

Author List

Juern JS, Milia D, Codner P, Beckman M, Somberg L, Webb T, Weigelt JA

Authors

Marshall A. Beckman MD Professor in the Surgery department at Medical College of Wisconsin
David J. Milia MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Angiography
Contrast Media
Embolization, Therapeutic
Extravasation of Diagnostic and Therapeutic Materials
Female
Fractures, Bone
Hemorrhage
Humans
Injury Severity Score
Iohexol
Male
Middle Aged
Pelvic Bones
Predictive Value of Tests
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed
Trauma Centers
Wounds, Nonpenetrating