title: Clinical significance of computed tomography contrast extravasation in blunt trauma patients with a pelvic fracture.
abstract: Blunt pelvic fractures can be associated with major pelvic bleeding. The significance of contrast extravasation (CE) on computed tomography (CT) is debated. We sought to update our experience with CE on CT scan for the years 2009-2014 to determine the accuracy of CE in predicting the need for angioembolization.
  
  
  
  This is a retrospective review of the trauma registry and our electronic medical record from a Level I trauma center. Patients seen from July 1, 2009, to September 7, 2014, with blunt pelvic fractures and contrast-enhanced CT were included. Standard demographic, clinical, and injury data were obtained. Patient records were queried for CE, performance of angiography, and angioembolization. Positive patients were those where CE was associated with active bleeding requiring angioembolization. All other patients were considered negative.
  
  
  
  There were 497 patients during the study time period with blunt pelvic fracture meeting inclusion criteria, and 75 patients (15%) had CE. Of those patients with CE, 30 patients (40%) underwent angiography, and 17 patients (23%) required angioembolization. The sensitivity, specificity, positive predictive value, and negative predictive value of CE on CT were 100%, 87.9%, 22.7%, and 100%, respectively. Two patients without CE underwent angiography but did not undergo embolization. Patients with CE had higher mortality (13 vs. 6%, p < 0.05) despite not having higher ISS scores.
  
  
  
  This study reinforces that CE on CT pelvis with blunt trauma is common, but many patients will not require angioembolization. The negative predictive value of 100% should be reassuring to trauma surgeons such that if a modern CT scanner is used, and there is no CE seen on CT, then the pelvis will not be a source of hemorrhagic shock. All of these findings are likely due to both increased comfort with observing CEs and the increased sensitivity of modern CT scanners.
  
  
  
  Therapeutic/care management study, level IV.
authors: From the Division of Trauma/Critical Care, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Jeremy S
authors: JS
authors: Juern
authors: David
authors: D
authors: Milia
authors: Panna
authors: P
authors: Codner
authors: Marshall
authors: M
authors: Beckman
authors: Lewis
authors: L
authors: Somberg
authors: Travis
authors: T
authors: Webb
authors: John A
authors: JA
authors: Weigelt
mesh_terms: D000328:Adult; D000792:Angiography; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D006801:Humans; D015601:Injury Severity Score; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy
chemical_list: D003287:Contrast Media; D007472:Iohexol