Accuracy of Contrast Extravasation on Computed Tomography for Diagnosing Severe Pelvic Hemorrhage in Pelvic Trauma Patients: A Meta-Analysis

Abstract

Background and objective: The early detection of underlying hemorrhage of pelvic trauma has been a critical issue. The aim of this study was to systematically determine the diagnostic accuracy of computed tomography (CT) for detecting severe pelvic hemorrhage. Materials and Methods: Relevant articles were obtained by searching PubMed, EMBASE, and Cochrane databases through 28 November 2020. Diagnostic test accuracy results were reviewed to obtain the sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve of CT for the diagnosis in pelvic trauma patients. The positive finding on CT was defined as the contrast extravasation. As the reference standard, severe pelvic hemorrhage was defined as an identification of bleeding at angiography or by direct inspection using laparotomy that required hemostasis by angioembolization or surgery. A subgroup analysis was performed according to the CT modality that is divided by the number of detector rows. Result: Thirteen eligible studies (29 subsets) were included in the present meta-analysis. Pooled sensitivity of CT was 0.786 [95% confidence interval (CI), 0.574–0.909], and pooled specificity was 0.944 (95% CI, 0.900–0.970). Pooled sensitivity of the 1–4 detector row group and 16–64 detector row group was 0.487 (95% CI, 0.215–0.767) and 0.915 (95% CI, 0.848–0.953), respectively. Pooled specificity of the 1–4 and 16–64 detector row groups was 0.956 (95% CI, 0.876–0.985) and 0.906 (95% CI, 0.828–0.951), respectively. Conclusion: Multi-detector CT with 16 or more detector rows has acceptable high sensitivity and specificity. Extravasation on CT indicates severe hemorrhage in patients with pelvic trauma.

Extravasation and outcomes in computed tomography and angiography in patients with pelvic fractures requiring transcatheter arterial embolization: A single-center observational study

“…Extravasation on CECT is considered a marker for traumatic vascular injury and active arterial bleeding. Moreover, it is an indicator for angiography 3,4,6,17–23 . In this retrospective study, angiography was performed in most cases because there was extravasation.…”

“…Moreover, it is an indicator for angiography. 3,4,6,[17][18][19][20][21][22][23] In this retrospective study, angiography was performed in most cases because there was extravasation. In contrast, patients who have extravasation on angiography even though it is absent on CECT may be judged to be out of the indication criteria for angiography and TAE according to the general pattern.…”

“…Even if CECT does not show extravasation, angiography may be performed, based on comprehensive indications such as the patient's age, hemodynamics, pelvic fracture morphology, and the size of the hematoma. 3,4,[11][12][13][14][15][16][17][18] Extravasation may be observed on angiography even if absent on CECT, and in some cases, transcatheter arterial embolization (TAE) would be determined to be necessary. 11,12 Extravasation on CECT in pelvic fractures is an accurate indicator of active bleeding and a helpful indicator of the need for IVR.…”

“…11,12 Extravasation on CECT in pelvic fractures is an accurate indicator of active bleeding and a helpful indicator of the need for IVR. 3,4,[17][18][19][20][21][22][23] On the other hand, there may be a contradiction where extravasation is observed on computed tomography (CT) but not in angiography, and vice versa. 4,11,12,24,25 Contrast-enhanced computed tomography has low sensitivity and specificity, and low blood pressure is a good index for arterial bleeding in angiography and determination of TAE indication.…”

“…Although there are some guidelines on treatment indications, the interpretation of contrast-enhanced computed tomography (CECT) and hemodynamics is mainly done at the discretion of an emergency physician. Even if CECT does not show extravasation, angiography may be performed, based on comprehensive indications such as the patient’s age, hemodynamics, pelvic fracture morphology, and the size of the hematoma 3,4,11–18 . Extravasation may be observed on angiography even if absent on CECT, and in some cases, transcatheter arterial embolization (TAE) would be determined to be necessary 11,12 …”