| Pelvic angiography for recurrent traumatic pelvic arterial hemorrhage. | |
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MedLine Citation:
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PMID: 16385296 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Angiography is the gold standard for the diagnosis and treatment of pelvic arterial hemorrhage associated with pelvic fractures. In most cases, a single angiogram with embolization is adequate to control pelvic arterial hemorrhage. However, a small subset of patients, require repeat pelvic angiogram to evaluate and treat recurrent hemorrhage. This study seeks to define this population and determine clinical predictors of recurrent hemorrhage. METHODS: We conducted a retrospective case control study comparing patients with traumatic pelvic fracture undergoing repeated pelvic angiogram versus a single angiogram between the years 1995 and 2000. Stepwise logistic regression was used to identify the independent predictors of recurrent hemorrhage. RESULTS: In the years studied, 556 patients underwent a pelvic angiogram to evaluate for pelvic arterial hemorrhage associated with pelvic fractures. Among these, 42 (7.5%) patients underwent a second angiogram for suspected recurrent hemorrhage. In comparison to the initial angiogram, the source of bleeding on the repeat angiogram occurred at a new bleeding site in 68%, at a previously embolized site in 18%, and both in 14%. Significant risk factors for recurrent pelvic arterial hemorrhage included hypotension or transfusion of >2 U of blood per hour before the initial angiogram, pubic symphysis widening, and more than two injured arteries requiring embolization (p < 0.05). Of these, more than two injured arteries requiring embolization (odds ratio, 16.0; 95% confidence interval, 2.9-88) and transfusion of >2 U of blood per hour (odds ratio, 6.9; 95% confidence interval,1.9-25) were independent predictors of recurrent hemorrhage. CONCLUSION: Angiographic control of traumatic pelvic arterial hemorrhage is highly successful. However, recurrent pelvic arterial hemorrhage does occur. We identified a subgroup of patients with pelvic fractures who are at increased risk of recurrent pelvic arterial hemorrhage and should be considered for early repeat angiography for signs of ongoing hemorrhage. |
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Authors:
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David Gourlay; Eric Hoffer; Milton Routt; Eileen Bulger |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Journal of trauma Volume: 59 ISSN: 0022-5282 ISO Abbreviation: J Trauma Publication Date: 2005 Nov |
Date Detail:
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Created Date: 2005-12-30 Completed Date: 2006-02-03 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
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Languages: eng Pagination: 1168-73; discussion 1173-4 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acetabulum
/
blood supply,
injuries,
radiography Adult Female Fractures, Closed / radiography* Hemorrhage / radiography* Humans Injury Severity Score Logistic Models Male Middle Aged Pelvic Bones / injuries* Pelvis / blood supply*, radiography* Pubic Bone / blood supply, injuries, radiography Recurrence Risk Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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