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The diagnostic accuracy of 64-slice computed tomography in detecting clinically significant arterial bleeding after pelvic fractures.
MedLine Citation:
PMID:  21944627     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
The purpose of this study was to determine the diagnostic accuracy of the 64-slice multidetector computed tomography (MDCT) in detecting active pelvic arterial bleeding associated with blunt pelvic fractures. We hypothesized that this modality yields high accuracy. We conducted a retrospective review of all MDCT detected pelvic fractures over an 18-month period admitted to LAC+ USC Medical Center, a Level 1 trauma center. The main outcome was the presence of contrast extravasation (CE) on admission MDCT, consistent with clinically significant arterial bleeding requiring a subsequent embolization or intraoperative ligation of pelvic arteries. Overall, 127 patients met study criteria and 12 per cent (n = 15) had CE on admission MDCT of which four were managed conservatively. Eighty-two per cent (n = 9) of the remaining 11 patients who went on to have invasive procedure had active arterial bleeding that required embolization or surgical ligation. Two of the 112 (1.8%) patients without CE on their admission MDCT were subjected to embolization after further investigation with angiography as a result of the severity of their pelvic fracture and continuous transfusion requirements. The calculated sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the 64-slice MDCT to identify clinically relevant arterial bleeding were 82, 95, 60, 98, and 94 per cent, respectively. The modern 64-slice MDCT provides relatively high diagnostic accuracy in detecting a clinically relevant arterial hemorrhage after blunt pelvic fracture. Nevertheless, in patients with clinical signs of ongoing hemorrhage, timely angiography or operative intervention is warranted, even in the absence of MDCT contrast extravasation.
Authors:
Shahin Mohseni; Peep Talving; Leslie Kobayashi; Lydia Lam; Kenji Inaba; Bernardino Castelo Branco; Matthew Oliver; Demetrios Demetriades
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  77     ISSN:  1555-9823     ISO Abbreviation:  Am Surg     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1176-82     Citation Subset:  IM    
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