Clinical Decisionmaking

CT scans can help physicians determine which artery is bleeding in patients with traumatic pelvic fractures

Pelvic fractures account for about 5 percent of all trauma admissions, with 5 to 15 percent of these patients dying. Hemorrhage is frequently the primary cause of death, usually within 24 hours of injury. Pelvic computerized tomography (CT) can quickly predict the source of arterial hemorrhage in these patients, according to the findings of a study supported in part by the Agency for Healthcare Research and Quality (K08 HS11291). Identifying the source of hemorrhage is the first step in stopping the life-threatening bleed, notes C. Craig Blackmore, M.D., Ph.D.

Dr. Blackmore and colleagues from the University of Washington digitized CT scans of 104 patients with traumatic pelvic fractures who had undergone emergency pelvic angiography (x-ray visualization of the blood vessels following injection of a contrast dye). They compared clots that measured more than 10 cm² (substantial clots) on the scan with specific arterial injuries found on angiography.

Overall, 58 percent of the patients had arterial bleeding at angiography. The presence of a clot greater than 10 cm² was a frequent indicator of injury to an artery passing through the region. For example, a patient with a substantial clot in the left pelvic sidewall region at the level of the sciatic notch had nearly triple the risk of injury to the left superior gluteal artery as patients who did not have a clot at this location.

A clot greater than 10 cm² in the rectus sheath region at the top of the iliac crest, areas of the pelvic sidewall, and certain gluteal regions was a significant indicator of unspecific arterial bleeding. The pre-sacral region was not significant at any level, indicating that blood in the presacral area is just as likely to be venous (much less serious) as arterial.

See "Can CT predict the source of arterial hemorrhage in patients with pelvic fractures?" by Meghan K. Sheridan, Dr. Blackmore, Ken F. Linnau, and others, in the October-November 2002 Emergency Radiology 9, pp. 188-194.

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