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May 2003

Assessment of Volume of Hemorrhage and Outcome From Pelvic Fracture

Author Affiliations

From the Harborview Injury Prevention and Research Center (Drs Blackmore, Jurkovich, Linnau, Cummings, and Rivara), the Departments of Radiology (Drs Blackmore, Linnau, and Hoffer) and Surgery (Dr Jurkovich), Harborview Medical Center, and the Departments of Epidemiology (Dr Cummings) and Pediatrics (Dr Rivara), University of Washington, Seattle.

Arch Surg. 2003;138(5):504-509. doi:10.1001/archsurg.138.5.504

Hypothesis  Measurement of pelvic hemorrhage on computed tomographic (CT) scans can estimate the pelvic fracture component of total patient blood loss and predict the need for angiography.

Design  Retrospective cohort study.

Setting  Large level 1 trauma center.

Patients  We examined data from 759 consecutive, nonreferral blunt trauma patients who sustained pelvic fracture.

Main Outcome Measures  Pelvic-fracture–specific outcomes included estimation of extraperitoneal pelvic hemorrhage volume from emergency department CT scans and determination of arterial injury from angiograms. General patient outcomes determined from medical record review included transfusion requirement, estimated blood loss, and mortality. Subanalysis was performed on subjects with only pelvic fracture as a source of major hemorrhage (derived from discharge International Classification of Diseases, Ninth Revision, Clinical Modification codes).

Results  Overall mortality was 96 (13%) of 759 patients. Blood transfusion was given to 418 (55%) patients, and 258 (34%) received 6 or more units in the first 72 hours. Pelvic-fracture–related hemorrhage averaged 149 mL (range, 0-1423 mL). Angiography was performed on 163 patients, of whom 113 had arterial injury. Higher pelvic hemorrhage volumes on CT scans were seen in subjects with pelvic arterial injury demonstrated on angiograms (P<.001). In subjects without another source of major hemorrhage, pelvic CT hemorrhage volumes were strongly associated with transfusion requirement (P<.001). Subjects with large pelvic hemorrhage volumes (>500 mL) were more likely to have pelvic arterial injury (risk ratio, 4.8; 95% confidence interval, 3.0-7.8; P<.001) and require large-volume (≥6 U) transfusions (risk ratio, 4.7; 95% confidence interval, 1.8-12.3; P<.001) than patients with smaller pelvic hemorrhage volumes.

Conclusion  Pelvic hemorrhage volumes derived from pelvic CT scans were predictors of the need for pelvic arteriography and transfusions.