Brun Julien, Guillot Stéphanie, Bouzat Pierre, Broux Christophe, Thony Frédéric, Genty Céline, Heylbroeck Christophe, Albaladejo Pierre, Arvieux Catherine, Tonetti Jérôme, Payen Jean-Francois
Department of Anesthesiology and Critical Care, Michallon Hospital, and UJF-Grenoble 1, Grenoble F-30843, France.
Injury. 2014 Jan;45(1):101-6. doi: 10.1016/j.injury.2013.06.011. Epub 2013 Jul 8.
The early diagnosis of pelvic arterial haemorrhage is challenging for initiating treatment by transcatheter arterial embolization (TAE) in multiple trauma patients. We use an institutional algorithm focusing on haemodynamic status on admission and on a whole-body CT scan in stabilized patients to screen patients requiring TAE. This study aimed to assess the effectiveness of this approach.
This retrospective cohort study included 106 multiple trauma patients admitted to the emergency room with serious pelvic fracture [pelvic abbreviated injury scale (AIS) score of 3 or more].
Of the 106 patients, 27 (25%) underwent pelvic angiography leading to TAE for active arterial haemorrhage in 24. The TAE procedure was successful within 3h of arrival in 18 patients. In accordance with the algorithm, 10 patients were directly admitted to the angiography unit (n=8) and/or operating room (n=2) for uncontrolled haemorrhagic shock on admission. Of the remaining 96 stabilized patients, 20 had contrast media extravasation on pelvic CT scan that prompted pelvic angiography in 16 patients leading to TAE in 14. One patient underwent a pelvic angiography despite showing no contrast media extravasation on pelvic CT scan. All 17 stabilized patients who underwent pelvic angiography presented a more severely compromised haemodynamic status on admission, and they required more blood products during their initial management than the 79 patients who did not undergo pelvic angiography. The incidence of unstable pelvic fractures was however comparable between the two groups. Overall, haemodynamic instability and contrast media extravasation on the CT-scan identified 26 out of the 27 patients who required subsequent pelvic angiography leading to TAE in 24.
An algorithm focusing on haemodynamic status on arrival and on the whole-body CT scan in stabilized patients may be effective at triaging multiple trauma patients with serious pelvic fractures.
对于多发伤患者，早期诊断盆腔动脉出血对于启动经导管动脉栓塞术（TAE）治疗具有挑战性。我们采用一种基于入院时血流动力学状态以及对病情稳定患者进行全身CT扫描的机构性算法，以筛选需要TAE治疗的患者。本研究旨在评估该方法的有效性。
这项回顾性队列研究纳入了106例因严重骨盆骨折（骨盆简明损伤定级标准[AIS]评分为3分或更高）而入住急诊室的多发伤患者。
106例患者中，27例（25%）接受了盆腔血管造影，其中24例因活动性动脉出血而进行了TAE。18例患者在到达后3小时内TAE手术成功。根据该算法，10例患者因入院时出血性休克无法控制而直接被送入血管造影科（n = 8）和/或手术室（n = 2）。在其余96例病情稳定的患者中，20例在盆腔CT扫描时有造影剂外渗，这促使16例患者进行了盆腔血管造影，其中14例进行了TAE。1例患者尽管盆腔CT扫描未显示造影剂外渗，但仍接受了盆腔血管造影。所有17例接受盆腔血管造影的病情稳定患者入院时血流动力学状态受损更严重，与79例未接受盆腔血管造影的患者相比，他们在初始治疗期间需要更多的血液制品。然而，两组间不稳定骨盆骨折的发生率相当。总体而言，血流动力学不稳定和CT扫描上的造影剂外渗在27例需要后续盆腔血管造影并导致24例进行TAE的患者中识别出了26例。
一种基于入院时血流动力学状态以及对病情稳定患者进行全身CT扫描的算法，可能在对伴有严重骨盆骨折的多发伤患者进行分诊时有效。
