Predictors of death in patients with life-threatening pelvic hemorrhage after successful transcatheter arterial embolization.
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.


CONCLUSIONS
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.
Hagiwara
Akiyoshi
A
Department of Traumatology and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan. hagiwarapupu@jcom.home.ne.jp
Minakawa
Kunitomo
K
Fukushima
Hideki
H
Murata
Atsuo
A
Masuda
Hiroharu
H
Shimazaki
Shuji
S
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D016009:Chi-Square Distribution; D002648:Child; D004621:Embolization, Therapeutic; D005260:Female; D015600:Glasgow Coma Scale; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors