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Angiography in patients with pelvic fractures and contrast extravasation on CT following high-energy trauma

Abstract

Introduction

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.

Methods

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.

Results

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).

Conclusion

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.

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Authors and Affiliations

Authors

Contributions

Conceptualization: IJ, YH. Methodology: IJ, YH. Formal analysis and investigation: IJ, IA, JH. Writing—original draft preparation: JH, YH. Writing—review and editing: IJ, ZS, IA.

Corresponding author

Correspondence to Yehuda Hershkovitz.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was approved by the institution’s research ethics committee (protocol 62-20).

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Cite this article

Hammerschlag, J., Hershkovitz, Y., Ashkenazi, I. et al. Angiography in patients with pelvic fractures and contrast extravasation on CT following high-energy trauma. Eur J Trauma Emerg Surg 48, 1939–1944 (2022). https://doi.org/10.1007/s00068-021-01628-w

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  • DOI: https://doi.org/10.1007/s00068-021-01628-w

Keywords

  • Pelvic fracture
  • Angiography
  • Bleeding
  • Angioembolization
  • Contrast extravasation