title: Does the size of the hemoperitoneum help to discriminate the bleeding source and guide therapeutic decisions in blunt trauma patients with pelvic ring fracture?
abstract: BACKGROUND
  In blunt trauma patients with a hemoperitoneum and a pelvic injury, multiple sources of active bleeding may exist. The purpose of this study was to determine whether the size of the hemoperitoneum helps to establish the bleeding source and guide therapeutic decisions in patients with pelvic fractures.
  
  
  METHODS
  The charts of patients with pelvic fractures admitted to a trauma intensive care unit from January 2005 to December 2009 were reviewed retrospectively. The hemoperitoneum size was defined by semiquantitative analysis (minimal/none, moderate, and large) using the Federle score on computed tomographic scan or during laparotomy. Active peritoneal hemorrhages requiring immediate laparotomy were compared according to hemoperitoneum size.
  
  
  RESULTS
  Of 185 patients, hemoperitoneum did not occur in 116 patients, moderate in 43, and large in 26. Among 102 patients (55%) who were hypotensive (systolic blood pressure <90 mm Hg) on admission, 27 needed therapeutic laparotomy and 15 needed pelvic embolization. Laparotomy (39% vs. 2%) and pelvic embolization (22% vs. 4%) were required significantly more often in patients with hemoperitoneum (moderate or large) than those without hemoperitoneum. The positive predictive value for an active peritoneal hemorrhage derived from qualitative analysis of the hemoperitoneum (moderate or large) was 39% (4% in hypotensive patients and 40% in those requiring pelvic embolization). The corresponding values for large hemoperitoneum only (semiquantitative analysis) were 62%, 70%, and 67%, respectively.
  
  
  CONCLUSIONS
  In patients with pelvic fractures, hemoperitoneum does not mean peritoneal injury requiring hemostatic procedure. Semiquantitative analysis of the hemoperitoneum improves predictability of peritoneal hemorrhage than qualitative analysis of hemoperitoneum. However, there remains numerous false-positives even in presence of large hemoperitoneum associated with hypotension.
authors: Department of Anesthesiology and Critical Care, Montpellier I University, Montpellier, France. j-charbit@chu-montpellier.fr
authors: Jonathan
authors: J
authors: Charbit
authors: Ingrid
authors: I
authors: Millet
authors: Orianne
authors: O
authors: Martinez
authors: Jean-Paul
authors: JP
authors: Roustan
authors: Samuel
authors: S
authors: Merigeaud
authors: Patrice
authors: P
authors: Taourel
authors: Xavier
authors: X
authors: Capdevila
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006465:Hemoperitoneum / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis / Q000628:therapy