Hammerschlag Jonathan, Hershkovitz Yehuda, Ashkenazi Itamar, Shapira Zahar, Jeroukhimov Igor
Division of Surgery, Shamir Medical Center Affiliated With University Tel Aviv, 70300, Zerifin, Israel.
Trauma Unit, Shamir Medical Center Affiliated With University Tel Aviv, 70300, Zerifin, Israel.
Eur J Trauma Emerg Surg. 2022 Jun;48(3):1939-1944. doi: 10.1007/s00068-021-01628-w. Epub 2021 Mar 4.
Pelvic fracture may be accompanied by severe bleeding. Computed tomography (CT) is a gold standard diagnostic tool in stable trauma patients. Contrast extravasation detected on CT of pelvis is a sign of hemorrhage, but its significance is not clear. We aimed to evaluate the need for angiography in patients with pelvic fracture and CT revealed contrast extravasation. We tried to identify parameters that might help to choose patients who will benefit from therapeutic angiography.
Electronic medical records of patients with pelvic fracture admitted to Level II Trauma Center during 10 years were retrospectively reviewed. Patients who had contrast extravasation on CT were included. Data base consisted of demographics, injury severity, initial physiologic parameters, laboratory data, results of CT and angiography.
Forty out of 396 patients had contrast extravasation detected by CT. Twelve patients underwent angiography and 4 of them benefited from embolization. The sensitivity of contrast extravasation in evaluating the need for embolization was 1.0 (95% CI 0.398, 1.0), positive predictive value was 0.1 (95% CI 0.028, 0.237), and the negative predictive value was 1.0 (95% CI 0.990, 1.0).
The role of angiography in stable patients with pelvic fracture and CT identified contrast extravasation remains questionable. Most of these patients are not in need of angioembolization.
骨盆骨折可能伴有严重出血。计算机断层扫描（CT）是稳定创伤患者的金标准诊断工具。骨盆CT上检测到的造影剂外渗是出血的迹象，但其意义尚不清楚。我们旨在评估骨盆骨折且CT显示造影剂外渗的患者是否需要进行血管造影。我们试图确定可能有助于选择能从治疗性血管造影中获益的患者的参数。
回顾性分析了10年间入住二级创伤中心的骨盆骨折患者的电子病历。纳入CT显示有造影剂外渗的患者。数据库包括人口统计学、损伤严重程度、初始生理参数、实验室数据、CT和血管造影结果。
396例患者中有40例经CT检测到造影剂外渗。12例患者接受了血管造影，其中4例从栓塞治疗中获益。造影剂外渗评估栓塞需求的敏感性为1.0（95%可信区间0.398，1.0），阳性预测值为0.1（95%可信区间0.028，0.237），阴性预测值为1.0（95%可信区间0.990，1.0）。
血管造影在骨盆骨折稳定且CT显示造影剂外渗的患者中的作用仍存在疑问。这些患者中的大多数不需要血管栓塞治疗。
