Predictors of the need for angioembolization in blunt pelvic trauma.

Abstract

Background: Vascular injury following blunt pelvic fractures is a major source of morbidity and mortality. Angioembolization has become the standard of care for patients with contrast extravasation (CE) on CT scan; however, there are patients without CE who have a vascular injury. We aimed to determine the predictors of the need for angioembolization in patients with blunt pelvic fractures.

Methods: We performed a retrospective case-control study of blunt trauma patients with pelvic fractures who underwent angiography by interventional radiology (IR) at a single institution from 2018 to 2023. Patients with CE on CT scan were compared with patients without CE to determine the risk factors for a positive angiogram. A multivariable logistic regression analysis was conducted to assess the factors associated with having a positive angiogram.

Results: 167 patients with blunt pelvic fractures underwent angiography: 120 with CE and 47 without CE on CT scan. Both groups were severely injured with a mean Injury Severity Score of 31; over 85% of patients requiring blood prior to angiography and 45% requiring massive transfusion protocol (MTP). There was no difference in rates of positive angiogram between patients with and without CE on CT scan (83% vs. 93%, p=0.08). Of the 47 patients without CE on their CT scan, 27 (57%) had active extravasation on angiography and an additional 12 (26%) had an injury requiring intervention. Initial systolic blood pressure, receiving blood prior to angiography, MTP activation, and CE on initial CT scan were not independently predictive of positive angiogram.

Conclusion: Although CE on CT scan is often the initial trigger for IR consultation for angiography in trauma patients with pelvic fractures, there are patients without CE who have an injury requiring intervention. In trauma patients with concerns for ongoing hemodynamic instability, IR consultation is reasonable even without CE on initial CT scan.

Level of evidence: Diagnostic test/criteria: level IV.