Significance of contrast extravasation in patients with pelvic fracture

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.

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.

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.

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%.