Clinical Decisionmaking

CT scans of pelvic fracture patients can determine the extent of hemorrhage and need for pelvic arteriography and transfusions

Patients who suffer pelvic fractures are usually the victims of trauma and often have other trauma-related injuries. Up to 52 percent of emergency department (ED) patients with pelvic fractures will develop shock due to hemorrhage. However, it's hard for the trauma surgeon to determine whether the shock is due to the pelvic fracture hemorrhage or hemorrhage from another source. According to a new study, computed tomographic (CT) scans of pelvic hematoma (collection of clotted blood) in these patients can help predict fracture-related blood loss and the need for angiography (x-ray visualization of blood vessels following injection of a contrast dye) to investigate arterial injury, as well as the need for blood transfusion.

In the study, which was supported by the Agency for Healthcare Research and Quality (K08 HS11291), C. Craig Blackmore, M.D., M.P.H., of Harborview Medical Center, and his colleagues examined data from 759 blunt trauma patients who sustained pelvic fracture. Overall mortality was 13 percent. Over half (55 percent) of the patients received blood transfusions, and 34 percent received six or more units of blood in the first 72 hours. Angiography was performed on 163 patients, of whom 113 had arterial injury.

Patients with large pelvic CT hemorrhage volumes were nearly five times as likely to have pelvic arterial injury and require large-volume (six or more units) transfusions as patients with smaller pelvic hemorrhage volumes. A simple estimate of whether the amount of pelvic hemorrhage is less than 200 mL or more than 500 mL allows the trauma surgeon to differentiate between patients who have a 5 percent vs. 45 percent probability of pelvic arterial injury. In the absence of substantial extraperitoneal hematoma (blood outside the abdominopelvic membrane) on CT scans, the probability of significant arterial hemorrhage was less than 5 percent. In this case, doctors should give priority to evaluating other potential sources of hemorrhage, concludes Dr. Blackmore.

See "Assessment of volume of hemorrhage and outcome from pelvic fracture," by Dr. Blackmore, Gregory J. Jurkovich, M.D., Ken F. Linnau, M.D., and others, in the May 2003 Archives of Surgery 138, pp. 504-509.

Return to Contents
Proceed to Next Article