1371 Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Acute Care Surgery, Grady Memorial Hospital, Atlanta, GA, USA.
Am Surg. 2021 Jun;87(6):913-918. doi: 10.1177/0003134820940246. Epub 2020 Dec 6.
In trauma patients with pelvic fractures, computed tomography (CT) scans are a critical tool to evaluate life-threatening hemorrhage. Contrast extravasation, or "blush", on CT may be a sign of bleeding, prompting a consult for angiography and possible embolization. However, the utility of blush on CT is controversial. We sought to evaluate our experience with patients who sustained pelvic fractures and had blush on CT.
A retrospective review was performed for all patients with blunt pelvic fractures between January 1, 2017 and December 31, 2018. Demographic, clinical, radiographic, and injury data were obtained. Comparison of mortality, hospital length of stay (LOS), and intensive care unit (ICU) LOS was performed for 3 subgroups: angio versus no angio; embo versus no embo; prophylactic embo versus therapeutic embo. We also calculated the sensitivity, specify, positive predictive value (PPV), and negative predictive value (NPV) of CT blush to predict the need for embolization.
889 patients were found to have a blunt pelvic fracture. 51 patients had blush on CT scan. 29 (56.9%) underwent angiography. 17 (58.6%) of these 29 patients were found to have extravasation and were embolized. 12 patients had an angio with no extravasation, and 6 of these patients (50%) underwent prophylactic embolization. No significant difference was found for hospital LOS, ICU LOS, or mortality in our 3 groups. Sensitivity, specificity, PPV, and NPV for CT blush were 74%, 96%, 33%, 99%, respectively.
Patients with active extravasation undergoing embolization had similar outcomes to patients without active extravasation. Blush on CT scan had low sensitivity and low PPV but high specificity and high NPV. Future studies need to include careful attention to the CT protocol utilized as well as patient selection.
在骨盆骨折的创伤患者中，计算机断层扫描（CT）是评估危及生命的出血的关键工具。CT 上的造影剂外渗，即“出血斑”，可能是出血的迹象，提示进行血管造影检查和可能的栓塞治疗。然而，CT 上的出血斑的作用仍存在争议。我们旨在评估我们对骨盆骨折且 CT 上有出血斑的患者的经验。
对 2017 年 1 月 1 日至 2018 年 12 月 31 日期间所有钝性骨盆骨折患者进行回顾性研究。获取人口统计学、临床、影像学和损伤数据。对血管造影组与非血管造影组、栓塞组与非栓塞组、预防性栓塞组与治疗性栓塞组的死亡率、住院时间（LOS）和重症监护病房（ICU）LOS 进行比较。我们还计算了 CT 出血斑预测栓塞需求的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
发现 889 例患者有钝性骨盆骨折。51 例患者 CT 扫描有出血斑。29 例（56.9%）患者进行了血管造影。这 29 例患者中，17 例（58.6%）发现造影剂外渗并进行了栓塞。12 例患者血管造影未见外渗，其中 6 例（50%）进行了预防性栓塞。3 组患者的住院 LOS、ICU LOS 和死亡率无显著差异。CT 出血斑的敏感性、特异性、PPV 和 NPV 分别为 74%、96%、33%、99%。
接受栓塞治疗的有活动性外渗的患者与无活动性外渗的患者的结局相似。CT 扫描上的出血斑敏感性低，PPV 低，但特异性高，NPV 高。未来的研究需要仔细关注所使用的 CT 方案和患者选择。
