title: Spontaneous retroperitoneal hemorrhage.
abstract: BACKGROUND
  We evaluated patients with spontaneous retroperitoneal hemorrhage for reliable predictors of early diagnosis and improved outcomes.
  
  
  METHODS
  A retrospective chart review was done to determine patient demographic and laboratory findings, presenting symptoms, time to diagnosis, anticoagulant and/or antiplatelet agent use, transfusions, and patient outcome.
  
  
  RESULTS
  One hundred nineteen patients were identified; 14 (12%) died (mean age 77 +/- 9 years vs. 74 +/- 10 years for survivors [P = 0.235]). All nonsurvivors were on anticoagulants: 8 of 89 (9%) were on heparin or warfarin alone, and 6 of 23 (26% [P = 0.028]) were on a combined anticoagulant-antiplatelet regimen. Symptom onset to computed axial tomography (CAT) scan averaged 1.3 +/- 1.3 days for nonsurvivors versus 1.5 +/- 1.9 days for survivors (P = 0.778). Hemoglobin was 9.07 +/- 3.35 for nonsurvivors versus 9.60 +/- 2.07 for survivors (P = 0.435). Eighty-eight patients were transfused, and 10 died; 31 patients had no transfusion, and 4 of these died (P = 0.821).
  
  
  CONCLUSIONS
  A high index of clinical suspicion is necessary for diagnosis of spontaneous retroperitoneal hemorrhage because these patients present with a variety of symptoms. Prospective studies are necessary to determine whether earlier diagnosis combined with aggressive resuscitation can impact the high mortality rate seen in these patients.
authors.affiliation: Division of Trauma, Department of General Surgery, William Beaumont Hospital, 3601 W. Thirteen Mile, Royal Oak, MI 48073, USA.
authors.forename: Felicia A
authors.initials: FA
authors.lastname: Ivascu
authors.forename: Randy J
authors.initials: RJ
authors.lastname: Janczyk
authors.forename: Holly A
authors.initials: HA
authors.lastname: Bair
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Bendick
authors.forename: Greg A
authors.initials: GA
authors.lastname: Howells
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D001780:Blood Coagulation Tests; D001803:Blood Transfusion; D042241:Early Diagnosis; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006465:Hemoperitoneum / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D010976:Platelet Count; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000925:Anticoagulants; D006454:Hemoglobins; D010975:Platelet Aggregation Inhibitors