Management of pelvic ring fracture patients with a pelvic 'blush' on early computed tomography

摘要

BACKGROUND: The sliding computed tomographic (CT) scanner in our trauma resuscitation room can be used early in the assessment of pelvic ring fracture patients. We determined the association between the presence of a pelvic blush on CT scan and the need for pelvic hemorrhage control (PHC). We hypothesized that many pelvic blushes found early in the resuscitation phase can be safely managed without intervention. METHODS: Contrast-enhanced CT scans of pelvic ring fracture (pelvic ring disruption) patients admitted from January 1, 2004, to June 31, 2012, were reviewed for the presence of a pelvic blush. PHC was defined as requiring a surgical or radiologic intervention for pelvic bleeding. A subanalysis was performed in "isolated" pelvic fracture/blush patients (absence of a major nonpelvic bleeding source). RESULTS: Overall, 68 (42%) of 162 pelvic ring fracture patients and 53 (40%) of 134 isolated pelvic fracture patients had a pelvic blush. Of those 32 (47%) and 27 (51%) patients, respectively, required PHC. In the absence of a pelvic blush, 87 (93%) of 94 of all and 77 (95%) of 81 of isolated pelvic fracture patients did not require PHC. Of all patients with a pelvic blush and of isolated pelvic blush, those with PHC had a higher Injury Severity Score (ISS) (p = 0.01 and p = 0.05), base deficit (p = 0.03 and p = 0.01), as well as 24-hour and any packed red blood cells requirement (p <0.001 and p = 0.05; p <0.001 and p = 0.02). In isolated pelvic blush patients, there was a trend toward a higher hospital and hemorrhage-related mortality in patients with PHC (p = 0.06 and p = 0.06). CONCLUSION: In pelvic ring fracture patients, a pelvic blush on early contrast-enhanced CT is a frequent finding. Many patients with (particularly isolated) pelvic blushes have stable vital signs and can be managed without surgical or radiologic PHC. The need for an intervention for a pelvic blush seems to be determined by the presence of clinical signs of ongoing bleeding. LEVEL OF EVIDENCE: Therapeutic study, level IV. Prognostic/epidemiologic study, level III.