Document Detail


Does the size of the hemoperitoneum help to discriminate the bleeding source and guide therapeutic decisions in blunt trauma patients with pelvic ring fracture?
MedLine Citation:
PMID:  22743381     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In blunt trauma patients with a hemoperitoneum and a pelvic injury, multiple sources of active bleeding may exist. The purpose of this study was to determine whether the size of the hemoperitoneum helps to establish the bleeding source and guide therapeutic decisions in patients with pelvic fractures.
METHODS: The charts of patients with pelvic fractures admitted to a trauma intensive care unit from January 2005 to December 2009 were reviewed retrospectively. The hemoperitoneum size was defined by semiquantitative analysis (minimal/none, moderate, and large) using the Federle score on computed tomographic scan or during laparotomy. Active peritoneal hemorrhages requiring immediate laparotomy were compared according to hemoperitoneum size.
RESULTS: Of 185 patients, hemoperitoneum did not occur in 116 patients, moderate in 43, and large in 26. Among 102 patients (55%) who were hypotensive (systolic blood pressure <90 mm Hg) on admission, 27 needed therapeutic laparotomy and 15 needed pelvic embolization. Laparotomy (39% vs. 2%) and pelvic embolization (22% vs. 4%) were required significantly more often in patients with hemoperitoneum (moderate or large) than those without hemoperitoneum. The positive predictive value for an active peritoneal hemorrhage derived from qualitative analysis of the hemoperitoneum (moderate or large) was 39% (4% in hypotensive patients and 40% in those requiring pelvic embolization). The corresponding values for large hemoperitoneum only (semiquantitative analysis) were 62%, 70%, and 67%, respectively.
CONCLUSION: In patients with pelvic fractures, hemoperitoneum does not mean peritoneal injury requiring hemostatic procedure. Semiquantitative analysis of the hemoperitoneum improves predictability of peritoneal hemorrhage than qualitative analysis of hemoperitoneum. However, there remains numerous false-positives even in presence of large hemoperitoneum associated with hypotension.
Authors:
Jonathan Charbit; Ingrid Millet; Orianne Martinez; Jean-Paul Roustan; Samuel Merigeaud; Patrice Taourel; Xavier Capdevila
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  73     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-29     Completed Date:  2012-09-17     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  117-25     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology and Critical Care, Montpellier I University, Montpellier, France. j-charbit@chu-montpellier.fr
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MeSH Terms
Descriptor/Qualifier:
Adult
Chi-Square Distribution
Female
Fractures, Bone / complications*,  diagnosis,  therapy
Hemoperitoneum / etiology*,  pathology
Humans
Male
Middle Aged
Pelvic Bones / injuries*
Retrospective Studies
Severity of Illness Index
Trauma Centers
Wounds, Nonpenetrating / complications*,  diagnosis,  therapy

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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