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Predictors of the need for angioembolization in blunt pelvic trauma
Michele Fiorentino1, Ruoying Li2, Fei Ye3
1ChristianaCare, Newark, Delaware, USA.
Insights
Vascular injury in blunt pelvic fractures can occur even without contrast extravasation (CE) on CT scans. Interventional radiology consultation is recommended for hemodynamically unstable patients, regardless of CE findings, to identify injuries requiring angioembolization.
Area of Science:
- Trauma Surgery
- Interventional Radiology
- Emergency Medicine
Background:
- Blunt pelvic fractures frequently cause vascular injury, leading to significant morbidity and mortality.
- Angioembolization is standard for contrast extravasation (CE) on CT, but injuries exist without CE.
- Predicting the need for angioembolization in these patients is crucial.
Purpose of the Study:
- To identify predictors of angioembolization in blunt pelvic fracture patients.
- To compare outcomes between patients with and without CE on CT scans.
- To evaluate the utility of interventional radiology consultation in the absence of CE.
Main Methods:
- Retrospective case-control study (2018-2023) of blunt trauma patients with pelvic fractures undergoing angiography.
- Comparison of patients with and without CE on CT scans.
- Multivariable logistic regression to identify factors associated with positive angiograms.
Main Results:
- 167 patients underwent angiography; 120 had CE, 47 did not. Both groups were severely injured (ISS 31), with high rates of blood transfusion (85%) and massive transfusion protocol (MTP) activation (45%).
- No significant difference in positive angiogram rates between groups (83% vs. 93%, p=0.08).
- 57% of patients without CE had active extravasation or injury requiring intervention on angiography. Initial SBP, pre-angiography blood transfusion, MTP activation, and CE were not independent predictors.
Conclusions:
- Contrast extravasation on CT does not solely identify patients needing angioembolization for blunt pelvic fractures.
- Interventional radiology consultation is valuable for hemodynamically unstable trauma patients with pelvic fractures, even without CE on initial CT.
- Early IR consultation can identify occult vascular injuries requiring intervention.
Background:
Vascular injury following blunt pelvic fractures is a major source of morbidity and mortality. Angioembolization has become the standard of care for patients with contrast extravasation (CE) on CT scan; however, there are patients without CE who have a vascular injury. We aimed to determine the predictors of the need for angioembolization in patients with blunt pelvic fractures.
Methods:
We performed a retrospective case-control study of blunt trauma patients with pelvic fractures who underwent angiography by interventional radiology (IR) at a single institution from 2018 to 2023. Patients with CE on CT scan were compared with patients without CE to determine the risk factors for a positive angiogram. A multivariable logistic regression analysis was conducted to assess the factors associated with having a positive angiogram.
Results:
167 patients with blunt pelvic fractures underwent angiography: 120 with CE and 47 without CE on CT scan. Both groups were severely injured with a mean Injury Severity Score of 31; over 85% of patients requiring blood prior to angiography and 45% requiring massive transfusion protocol (MTP). There was no difference in rates of positive angiogram between patients with and without CE on CT scan (83% vs. 93%, p=0.08). Of the 47 patients without CE on their CT scan, 27 (57%) had active extravasation on angiography and an additional 12 (26%) had an injury requiring intervention. Initial systolic blood pressure, receiving blood prior to angiography, MTP activation, and CE on initial CT scan were not independently predictive of positive angiogram.
Conclusion:
Although CE on CT scan is often the initial trigger for IR consultation for angiography in trauma patients with pelvic fractures, there are patients without CE who have an injury requiring intervention. In trauma patients with concerns for ongoing hemodynamic instability, IR consultation is reasonable even without CE on initial CT scan.
Level Of Evidence:
Diagnostic test/criteria: level IV.
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