title: Selective computed tomography and angioembolization provide benefits in the management of patients with concomitant unstable hemodynamics and negative sonography results.
abstract: BACKGROUND
  The FAST (focused assessment of sonography for trauma) examination can rapidly identify free fluid in the abdominal or thoracic cavity, which is indicative of hemorrhage requiring emergency surgery in multiple-trauma patients. In patients with negative FAST examination results, it is difficult to identify the site of the hemorrhage and to plan treatment accordingly. We attempted to delineate the role of selective computed tomography (CT) and transarterial angioembolization (TAE) in the management of such unstable patients.
  
  
  METHODS
  From January 2005 to April 2011 patients with concomitant unstable hemodynamics and negative FAST examination results were identified. Their demographic and time to start of embolization were recorded. The initial systolic blood pressure (SBP) in emergency department patients was compared with the SBP after TAE.
  
  
  RESULTS
  A total of 33 patients were enrolled, and 85% required TAE. SBP improved significantly after TAE. There were 18 patients who received TAE without CT scan because the site of hemorrhage was obvious. Fifteen patients received a CT scan during the time required for angiography preparation. Ten of them received subsequent TAE based on the CT scan findings, and the treatment plan was changed in the other five patients. There was no significant difference between patients with or without a CT scan with respect to the time interval between arrival and starting embolization.
  
  
  CONCLUSIONS
  Transarterial angioembolization is suggested in the management of patients with concomitant unstable hemodynamics and negative FAST examination results. During the time interval required for angiography preparation, a CT scan can be performed. This approach provides valuable information for further decision making without delaying definitive treatment.
authors.affiliation: Department of Trauma and Emergency Surgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan. drfu5564@yahoo.com.tw
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fu
authors.forename: Chi-Hsun
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Chun-Han
authors.initials: CH
authors.lastname: Shih
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Wang
authors.forename: Ray-Jade
authors.initials: RJ
authors.lastname: Chen
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Huang
authors.forename: Jui-Chien
authors.initials: JC
authors.lastname: Huang
authors.forename: Shih-Chi
authors.initials: SC
authors.lastname: Wu
authors.forename: Hsun-Chung
authors.initials: HC
authors.lastname: Tsuo
authors.forename: Hsiu-Jung
authors.initials: HJ
authors.lastname: Tung
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000628:therapy*; D000328:Adult; D000792:Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000628:therapy