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Research article
Yi-Hsun Yu
Chang Gung Memorial Hospital Linkou Branch
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3703-404X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background In most institutions, arterioembolisation (AE) remains a standard procedure to achieve haemostasis in the resuscitation of patients with pelvic fractures. However, the actual benefits from AE are controversial.
Methods We retrospectively reviewed data from patients with closed pelvic fractures between 2014 and 2017 in a single institute. The details of AE and clinical parameters were recorded and analysed to determine whether poor outcomes could be predicted.
Results During the study period, 545 patients with closed pelvic fractures were enrolled. Angiography was performed in 131 patients, and 129 patients underwent AE. The patients who underwent AE had higher injury severity score, more numbers of shock status on arrival, and higher incidence of unstable fracture patterns when compared to non-AE group. A higher number of patients who underwent AE required osteosynthesis and experienced surgical site infection (SSI) after osteosynthesis than those who did not receive AE. Nonselective bilateral internal iliac artery embolisation (nBIIAE) was the major approach for AE (74%). Overall, 11 patients experienced SSI in the AE group, 9 of whom had received nBIIAE. The positive predictive value of contrast extravasation (CE) on computed tomography (CT) was 29.6%, with a negative predictive value of 91.3%. Mortality was higher in patients without CE on CT than patients with identifiable CE (30.0% vs. 11.0%, p = 0.03).
Conclusion Using the finding of CE on CT examination as a decision for AE is not a reliable indicator because of its low positive predictive value. Considering the high incidence of SSI following nBIIAE, candidates should be carefully selected for this procedure. Other haemostasis procedures such as preperitoneal pelvic packing might be considered for select cases, given the high mortality rate among patients without CE during image studies, relative to patients with identifiable CE.
Keywords
trauma of pelvis, infection, major trauma management, resuscitation and critical care
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View the published article at BMC Musculoskeletal Disorders.
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Editorial decision: Minor revision
On 02 May, 2020
Review #3 received
Received 24 Apr, 2020
Review #2 received
Received 11 Apr, 2020
Reviewer #3 agreed
On 11 Apr, 2020
Reviewer #2 agreed
On 08 Apr, 2020
Review #1 received
Received 08 Apr, 2020
Reviewers invited
Invitations sent on 08 Apr, 2020
Reviewer #1 agreed
On 08 Apr, 2020
Editor assigned
On 06 Apr, 2020
Editor invited
On 05 Apr, 2020
Submission checks complete
On 05 Apr, 2020
Version 1
Posted 20 Jan, 2020
No comments provided
Review #2 received
Received 23 Mar, 2020
Editorial decision: Major revision
On 23 Mar, 2020
Review #3 received
Received 15 Mar, 2020
Reviewer #3 agreed
On 14 Mar, 2020
Reviewer #2 agreed
On 09 Mar, 2020
Review #1 received
Received 26 Jan, 2020
Reviewer #1 agreed
On 23 Jan, 2020
Reviewers invited
Invitations sent on 18 Jan, 2020
Editor assigned
On 16 Jan, 2020
Submission checks complete
On 16 Jan, 2020
Editor invited
On 16 Jan, 2020
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A new preprint design is coming!
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See the published version of this preprint at BMC Musculoskeletal Disorders.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Yi-Hsun Yu
Chang Gung Memorial Hospital Linkou Branch
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3703-404X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Musculoskeletal Disorders.
No community comments so far
Editorial decision: Minor revision
On 02 May, 2020
Review #3 received
Received 24 Apr, 2020
Review #2 received
Received 11 Apr, 2020
Reviewer #3 agreed
On 11 Apr, 2020
Reviewer #2 agreed
On 08 Apr, 2020
Review #1 received
Received 08 Apr, 2020
Reviewers invited
Invitations sent on 08 Apr, 2020
Reviewer #1 agreed
On 08 Apr, 2020
Editor assigned
On 06 Apr, 2020
Editor invited
On 05 Apr, 2020
Submission checks complete
On 05 Apr, 2020
Version 1
Posted 20 Jan, 2020
No comments provided
Review #2 received
Received 23 Mar, 2020
Editorial decision: Major revision
On 23 Mar, 2020
Review #3 received
Received 15 Mar, 2020
Reviewer #3 agreed
On 14 Mar, 2020
Reviewer #2 agreed
On 09 Mar, 2020
Review #1 received
Received 26 Jan, 2020
Reviewer #1 agreed
On 23 Jan, 2020
Reviewers invited
Invitations sent on 18 Jan, 2020
Editor assigned
On 16 Jan, 2020
Submission checks complete
On 16 Jan, 2020
Editor invited
On 16 Jan, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Musculoskeletal Disorders.
Background In most institutions, arterioembolisation (AE) remains a standard procedure to achieve haemostasis in the resuscitation of patients with pelvic fractures. However, the actual benefits from AE are controversial.
Methods We retrospectively reviewed data from patients with closed pelvic fractures between 2014 and 2017 in a single institute. The details of AE and clinical parameters were recorded and analysed to determine whether poor outcomes could be predicted.
Results During the study period, 545 patients with closed pelvic fractures were enrolled. Angiography was performed in 131 patients, and 129 patients underwent AE. The patients who underwent AE had higher injury severity score, more numbers of shock status on arrival, and higher incidence of unstable fracture patterns when compared to non-AE group. A higher number of patients who underwent AE required osteosynthesis and experienced surgical site infection (SSI) after osteosynthesis than those who did not receive AE. Nonselective bilateral internal iliac artery embolisation (nBIIAE) was the major approach for AE (74%). Overall, 11 patients experienced SSI in the AE group, 9 of whom had received nBIIAE. The positive predictive value of contrast extravasation (CE) on computed tomography (CT) was 29.6%, with a negative predictive value of 91.3%. Mortality was higher in patients without CE on CT than patients with identifiable CE (30.0% vs. 11.0%, p = 0.03).
Conclusion Using the finding of CE on CT examination as a decision for AE is not a reliable indicator because of its low positive predictive value. Considering the high incidence of SSI following nBIIAE, candidates should be carefully selected for this procedure. Other haemostasis procedures such as preperitoneal pelvic packing might be considered for select cases, given the high mortality rate among patients without CE during image studies, relative to patients with identifiable CE.
Figure 1
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