Ann Surg Treat Res.  2020 Mar;98(3):146-152. 10.4174/astr.2020.98.3.146.

The size of pelvic hematoma can be a predictive factor for angioembolization in hemodynamically unstable pelvic trauma

• Lee HJ
• No HK
• Choi NJ
• Sun HW
• Lee JS
• Jung YJ
• Hong SK

• KMID: 2471180
• DOI: http://doi.org/10.4174/astr.2020.98.3.146

Abstract

PURPOSE
Unstable pelvic fracture with bleeding can be fatal, with a mortality rate of up to 40%. Therefore, early detection and treatment are important in unstable pelvic trauma. We investigated the early predictive factors for possible embolization in patients with hemodynamically unstable pelvic trauma.
METHODS
From January 2011 to December 2013, 46 patients with shock arrived at a single hospital within 24 hours after injury. Of them, 44 patients underwent CT scan after initial resuscitation, except for 2 who were dead on arrival. Nine patients with other organ injuries were excluded. Seventeen patients underwent embolization. A single radiologist measured the width (longest length in axial view) and length (longest length in coronal view) of pelvic hematoma on CT scans. Demographic, clinical, and radiological data were reviewed retrospectively.
RESULTS
Among 35 patients with hemodynamically unstable pelvic fracture, 22 (62.9%) were men. Width (P = 0.002) and length (P = 0.006) of hematoma on CT scans were significantly different between the embolization and nonembolization groups. The predictors of embolization were width of pelvic hematoma (odds ratio [OR], 1.07; P = 0.028) and female sex (OR, 10.83; P = 0.031). The cutoff value was 3.35 cm. More embolization was performed (OR, 12.00; P = 0.003) and higher mortality was observed in patients with hematoma width >3.35 cm (OR, 4.96; P = 0.048).
CONCLUSION
Patients with hemodynamically unstable pelvic trauma have a high mortality rate. CT is useful for the initial identification of the need for embolization among these patients. The width of pelvic hematoma can predict possible embolization in patients with unstable pelvic trauma.

Keyword

Bone fractures; Hematoma; Therapeutic embolization; X-ray computed tomography

MeSH Terms

Embolization, Therapeutic
Female
Fractures, Bone
Hematoma*
Hemorrhage
Humans
Male
Mortality
Resuscitation
Retrospective Studies
Shock
Tomography, X-Ray Computed

Figure

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  Fig. 1 Inclusion criteria of patients in this study. sBP, systolic blood pressure.

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  Fig. 2 Measurement of pelvic hematoma on computed tomography scan. (A) The width of hematoma - longest length in the axial view, (B) the length of hematoma - longest length in the coronal view.

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  Fig. 3 Area under curve (AUC) of pelvic hematoma width (AUC = 0.822).

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