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Relative hypotension increases the probability of the need forangioembolisation in pelvic fracture patients without contrastextravasation on computed tomography scanLing-Wei Kuoa, Shang-Ju Yanga, Chih-Yuan Fua,*, Chien-Hung Liaoa, Shang-Yu Wanga,Shih-Chi WubaDepartment of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, TaiwanbDepartment of Surgery, China Medical University Hospital, China Medical University, TaiwanIntroductionPelvic fracture is an injury that results from a high kinetictrauma mechanism [1], and is often comorbid with injuries ofother organs and systems [2–4]. Most importantly, the associatedpelvic haemorrhage may be lethal [5,6]. The source of thehaemorrhage can be divided into three categories: bleeding fromthe arteries, bleeding from the venous plexus, and bleeding fromInjury, Int. J. Care Injured xxx (2015) xxx–xxx* Corresponding author at: Department of Trauma and Emergency Surgery,Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan,Taiwan. Tel.: +886 3 3281200 3651; fax: +886 3 3285818.E-mail addresses: m0102@cgmh.org.tw (L.-W. Kuo), m7205@cgmh.org.tw(S.-J. Yang), drfu5564@yahoo.com.tw (C.-Y. Fu), gymetliao@gmail.com (C.-H. Liao),m7026@cgmh.org.tw (S.-Y. Wang), rw114@mail.cmuh.org.tw (S.-C. Wu).A R T I C L E I N F OArticle history:Accepted 30 July 2015Keywords:Computed tomography scanPelvic fractureRelative hypotensionContrast extravasationA B S T R A C TIntroduction: In the evaluation of haemorrhage in trauma patients with pelvic fractures, contrastextravasation (CE) on computed tomography (CT) scan often implies active arterial bleeding. However,the absence of CE on CT scan does not always exclude the need for transcatheter arterial embolisation(TAE) to achieve haemostasis. In the current study, we evaluated the factors associated with the need forTAE in patients without CE on CT scan. These factors may be evaluated as adjuncts to CT scanning in themanagement of patients with pelvic fractures.Methods: We retrospectively reviewed our trauma registry and medical records of patients with pelvicfractures. When CE was observed, indicating active haemorrhage, the patients underwent TAE to achievehaemostasis. In contrast, patients without CE were held for observation and treatment of their injuries,and if their condition deteriorated after a delayed interval, they were then also referred for TAE if noother focus of haemorrhage was found. Patients without CE on CT scan but with retroperitonealhaemorrhage requiring TAE were investigated. Their demographic characteristics, associated injuries,fracture patterns, and changes in systolic blood pressure were described and analysed.Results: In total, 201 patients with pelvic fracture underwent CT scan examination; 47 (23.4%) had CE byCT scan, whereas the other 154 (76.6%) did not. Of the 154 patients who did not show CE by CT scan, 124(80.5%) patients never underwent TAE; however, 30 (19.5%) of these patients did eventually undergoTAE. In comparing the patients who underwent TAE to those who did not undergo TAE among patientswithout CE on CT scan, the systolic blood pressure (SBP) on arrival (median: 100.0 mmHg vs136.0 mmHg, p < 0.01) and the lowest SBP recorded in the ED (median: 68.0 mmHg vs 129.0 mmHg,p < 0.01) were significantly lower in the patients who underwent TAE. The ROC curve analysis revealedthat the most appropriate cutoff value of decrement of SBP (SBP on arrival minus the lowest SBP in theED) was 30 mmHg (AUC = 0.89).Conclusion: In the management of pelvic fracture patients, greater attention should be directed towardpatients with relative hypotension. The higher likelihood of haemodynamic deterioration and the needfor TAE for haemorrhage control should remain under consideration in such cases, despite the absence ofCE by CT scan.? 2015 Elsevier Ltd. All rights reserved.G ModelJINJ-6327; No. of Pages 6Please cite this article in press as: Kuo L-W, et al. Relative hypotension increases the probability of the need for angioembolisation inpelvic fracture patients without contrast extravasation on computed tomography scan. Injury (2015), http://dx.doi.org/10.1016/j.injury.2015.07.043Contents lists available at ScienceDirectInjuryjo ur n al ho m epag e: ww w.els evier .c om /lo cat e/inju r yhttp://dx.doi.org/10.1016/j.injury.2015.07.0430020–1383/? 2015 Elsevier Ltd. All rights reserved.