13th Annual Global Embolization Symposium & Technologies
Purpose : To evaluate our institutional standard trauma protocol computed tomography (CT) for the detection of acute traumatic pelvic hemorrhage which may benefit from trans-arterial embolization therapy on subsequent selective pelvic angiography.
Material and Methods : A retrospective chart review of patients who underwent pelvic angiography after trauma CT (tCT; late arterial/early portal venous phase) demonstrating pelvic injury between June 2014 and July 2018 was performed. A positive tCT was defined as extravasation noted in association with pelvic injury. Corresponding angiograms were considered positive if extravasation was noted on pelvic arteriograms. Demographic data, type of pelvic injury, co-existing traumatic injuries, hemodynamic parameters, relevant lab values (i.e hemoglobin (Hgb) concentration, platelets, INR) were recorded at presentation, time of tCT, time of angiography and post-angiography. Resuscitative measures and outcomes were also recorded. Sensitivity (SN), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) were calculated.
Results : 118 patients received a tCT for evaluation after presenting with trauma. Of these, 45 patients, 30 males (66.7%) and 15 females (33.3%) (mean age 49.7 +/- 22.6 yrs) met the inclusion criteria for this study. The sensitivity and specificity of tCT were 90.5% and 45.5% respectively. Furthermore, of 12 patients with a negative tCT, 10 had subsequent negative pelvic arteriography (NPV = 83.3%). 28 patients were embolized, 21 for active extravasation on angiography, 7 prophylactically. There were no procedural related complications. Average follow up time was 10 months. Two (4%) patients died at followup, one of them due to traumatic brain injury and the other due to sepsis secondary to
Conclusions : In the setting of pelvic trauma, a tCt can reliably rule out extravasation on angiography giving its high sensitivity. Furthermore, negative tCt will likely result in negative angiography given its high negative predictive power of tCt, and may be reliably used to stratify patients being considered for angiography.