Significance of contrast extravasation in patients with pelvic fracture

Karen Brasel, Khanh Pham, Hongyan Yang, Richard Christensen, John A. Weigelt

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

BACKGROUND: Contained contrast extravasation (CE) in solid organ injury is not well correlated with the need for operative intervention, but the significance of CE in patients with pelvic fracture is unknown. METHODS: The trauma registry at a Level I trauma center was queried for all patients with pelvic fracture from January 1, 1998 to May 31, 2005. All computed tomography (CT) scans used helical technology. Demographic and injury information were abstracted from the trauma registry and medical record. CT and angiography reports of all patients were reviewed. Angiograms and abdominal and pelvic CT studies (AP-CT) of patients with CE were then reviewed by a radiologist. RESULTS: A total of 604 patients with a pelvic fracture and an AP-CT were identified. Of these, 42 patients had a pelvic CE on CT study. Patients with CE had a higher Injury Severity Score (24.5 vs. 18.3, p <0.001) and higher mortality (24 vs. 6%, p <0.001). Twenty-five patients with CE underwent angiography, with CE confirmed in 19 patients and embolization performed in 17. Six patients without CE underwent angiography. CE was confirmed in two patients and both were embolized. A significantly higher number of patients undergoing angiography required ongoing transfusion. CONCLUSIONS: CE is a marker of severe injury but does not mandate angiography. Associated injuries are common and other sources of blood loss must be excluded. CE is not reliable enough to exclude significant vascular injury, as the therapeutic embolization rate for CE-negative patients undergoing angiography is 33%.

Original languageEnglish (US)
Pages (from-to)1149-1152
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume62
Issue number5
DOIs
StatePublished - May 2007
Externally publishedYes

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Angiography
Wounds and Injuries
Tomography
Registries
Therapeutic Embolization
Injury Severity Score
Trauma Centers
Vascular System Injuries
Medical Records
Demography
Technology
Mortality

Keywords

  • Blush
  • Computed tomography
  • Contrast extravasation
  • Pelvic fracture

ASJC Scopus subject areas

  • Surgery

Cite this

Significance of contrast extravasation in patients with pelvic fracture. / Brasel, Karen; Pham, Khanh; Yang, Hongyan; Christensen, Richard; Weigelt, John A.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 62, No. 5, 05.2007, p. 1149-1152.

Research output: Contribution to journalArticle

Brasel, Karen ; Pham, Khanh ; Yang, Hongyan ; Christensen, Richard ; Weigelt, John A. / Significance of contrast extravasation in patients with pelvic fracture. In: Journal of Trauma - Injury, Infection and Critical Care. 2007 ; Vol. 62, No. 5. pp. 1149-1152.
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N2 - BACKGROUND: Contained contrast extravasation (CE) in solid organ injury is not well correlated with the need for operative intervention, but the significance of CE in patients with pelvic fracture is unknown. METHODS: The trauma registry at a Level I trauma center was queried for all patients with pelvic fracture from January 1, 1998 to May 31, 2005. All computed tomography (CT) scans used helical technology. Demographic and injury information were abstracted from the trauma registry and medical record. CT and angiography reports of all patients were reviewed. Angiograms and abdominal and pelvic CT studies (AP-CT) of patients with CE were then reviewed by a radiologist. RESULTS: A total of 604 patients with a pelvic fracture and an AP-CT were identified. Of these, 42 patients had a pelvic CE on CT study. Patients with CE had a higher Injury Severity Score (24.5 vs. 18.3, p <0.001) and higher mortality (24 vs. 6%, p <0.001). Twenty-five patients with CE underwent angiography, with CE confirmed in 19 patients and embolization performed in 17. Six patients without CE underwent angiography. CE was confirmed in two patients and both were embolized. A significantly higher number of patients undergoing angiography required ongoing transfusion. CONCLUSIONS: CE is a marker of severe injury but does not mandate angiography. Associated injuries are common and other sources of blood loss must be excluded. CE is not reliable enough to exclude significant vascular injury, as the therapeutic embolization rate for CE-negative patients undergoing angiography is 33%.

AB - BACKGROUND: Contained contrast extravasation (CE) in solid organ injury is not well correlated with the need for operative intervention, but the significance of CE in patients with pelvic fracture is unknown. METHODS: The trauma registry at a Level I trauma center was queried for all patients with pelvic fracture from January 1, 1998 to May 31, 2005. All computed tomography (CT) scans used helical technology. Demographic and injury information were abstracted from the trauma registry and medical record. CT and angiography reports of all patients were reviewed. Angiograms and abdominal and pelvic CT studies (AP-CT) of patients with CE were then reviewed by a radiologist. RESULTS: A total of 604 patients with a pelvic fracture and an AP-CT were identified. Of these, 42 patients had a pelvic CE on CT study. Patients with CE had a higher Injury Severity Score (24.5 vs. 18.3, p <0.001) and higher mortality (24 vs. 6%, p <0.001). Twenty-five patients with CE underwent angiography, with CE confirmed in 19 patients and embolization performed in 17. Six patients without CE underwent angiography. CE was confirmed in two patients and both were embolized. A significantly higher number of patients undergoing angiography required ongoing transfusion. CONCLUSIONS: CE is a marker of severe injury but does not mandate angiography. Associated injuries are common and other sources of blood loss must be excluded. CE is not reliable enough to exclude significant vascular injury, as the therapeutic embolization rate for CE-negative patients undergoing angiography is 33%.

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