Can CT predict the source of arterial hemorrhage in patients with pelvic fractures?

Abstract.

The objective of the study was to evaluate the ability of hemorrhage site and location as demonstrated on pelvic CT to predict the source of arterial hemorrhage in patients with traumatic pelvic fractures. CT scans of 104 consecutive patients who had sustained traumatic pelvic fracture and undergone emergent pelvic angiography were digitized, and fracture-related hemorrhage area and volume were measured at multiple locations within the pelvis. Clots that measured greater than 10 cm² were compared to angiographic results. The χ² test was used to find locations on CT that were significantly associated with specific arterial injuries found on angiography. Sixty-one (58%) of the patients had arterial bleeding at angiography. The most commonly injured arteries were the internal pudendal and the superior gluteal. Specific locations on CT were statistically significant indicators of injury to the superior gluteal artery (relative risk=2.9, 95% CI 1.2–7.3, P=0.013), the anterior division of the internal iliac artery (relative risk=3.2, 95% CI 1.4–4.1, P=0.006), and the internal pudendal arteries (relative risk=2.0, 95% CI 1.1–4.0, P=0.037). More blood was visible on CT when an artery was injured (mean volume with negative angiogram=318 ml, mean volume with positive angiogram=554 ml, (P=0.007)). The rectus sheath region at the top of the iliac crest (P=0.004), pelvic sidewalls at the L5–S1 disk space level (P=0.001), and gluteal regions also at the L5–S1 disk space level (P=0.012) were significant indicators of a positive arteriogram. CT can help predict the specific bleeding artery to potentially guide angiographic intervention.