Document Detail


Predictors of death in patients with life-threatening pelvic hemorrhage after successful transcatheter arterial embolization.
MedLine Citation:
PMID:  14566125     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to determine predictors of death in patients with pelvic fracture whose pelvic arterial hemorrhage is controlled successfully by transcatheter arterial embolization (TAE). METHODS: From January 1996 to December 2000, 61 patients with a pelvic fracture who had pelvic arterial hemorrhage were treated at our Level I trauma center according to a protocol that assigns a high priority to diagnostic and therapeutic angiography within the algorithm. Angiography is performed before laparotomy in patients with hemoperitoneum, who can be stabilized by fluid resuscitation, and otherwise afterward. External fixation was performed immediately after TAE in the angiography suite. Predictors of outcome were determined retrospectively by univariate and multivariate analysis using anatomic and physiologic parameters. RESULTS: Forty-eight patients survived and 13 died. TAE successfully controlled pelvic arterial hemorrhage in all patients. Predictors of death included posterior pelvic arterial injury and an elevated Acute Physiology and Chronic Health Evaluation II score (odds ratio, 15.6 and 23.9, respectively). Need for fluid requirements to achieve hemodynamic stability were higher in nonsurvivors than in survivors. Outcome did not correlate with the type of fracture or the Injury Severity Score. CONCLUSION: Application of angiography as a therapeutic intervention in patients with pelvic arterial bleeding may reduce the need for surgery, thereby avoiding or minimizing this additional trauma.
Authors:
Akiyoshi Hagiwara; Kunitomo Minakawa; Hideki Fukushima; Atsuo Murata; Hiroharu Masuda; Shuji Shimazaki
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  55     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  2003 Oct 
Date Detail:
Created Date:  2003-10-20     Completed Date:  2003-11-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  696-703     Citation Subset:  AIM; IM    
Affiliation:
Department of Traumatology and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan. hagiwarapupu@jcom.home.ne.jp
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MeSH Terms
Descriptor/Qualifier:
APACHE
Adolescent
Adult
Aged
Aged, 80 and over
Angiography
Chi-Square Distribution
Child
Embolization, Therapeutic*
Female
Glasgow Coma Scale
Hemorrhage / etiology,  mortality*,  therapy*
Humans
Logistic Models
Male
Middle Aged
Pelvic Bones / injuries*
Predictive Value of Tests
Prospective Studies
Risk Factors

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


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