The role of multidetector computed tomography versus digital subtraction angiography in triaging care and management in abdominopelvic trauma

Hallinan, James Thomas Patrick Decourcy; Tan, Cher Heng; Pua, Uei

doi:10.11622/smedj.2015179

Cited by 9 publications

(8 citation statements)

References 17 publications

(30 reference statements)

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“…contrast media, CT identified RPH in all cases (100%) and may detect the source of bleeding (40%) by extravasation of contrast media [ 199 ]. Dual-phase contrast-enhanced CT (CECT) without CT angiography showed a high sensitivity (93.9%) and PPV (88.6%) compared with digital subtraction angiography for the detection of active haemorrhage in patients with blunt abdominopelvic trauma [ 200 ]. Anderson et al [ 201 , 202 ] found high accuracy in the evaluation of splenic injuries resulting from trauma after administration of an i.v.…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

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Background: Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. Methods: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reexamined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. Results: Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient-or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. Conclusions: A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.

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Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

et al. 2019

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“…The estimated contrast extravasation positive rate of patients was 0.234 (95% CI, 0.15–0.334; heterogeneity test, p < 0.001; Egger’s test, p = 0.529; 13 studies and 15 subsets) [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. The estimated points of contrast clinical characteristics according to contrast extravasation on CT are summarized in Table 2 [ 10 , 14 , 15 , 16 , 19 , 20 , 21 ]. Age, injury severity score, and mortality rate were significantly higher in the positive-extravasation group.…”

Section: Resultsmentioning

confidence: 99%

“…Only seven studies (53.8%) showed the time from admission to hemostasis (angioembolization or surgery). Moreover, several studies had a long duration from admission to identify the bleeding via angiography or surgery (7–24 h) [ 11 , 14 , 22 ]. Two studies had a significantly high risk of bias in terms of reference standards [ 16 , 21 ].…”

Section: Resultsmentioning

confidence: 99%

“…Data from all eligible studies were extracted by two investigators. Extracted data from each of the eligible studies included [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] the first author’s name, year of publication, study location, design, and period; the number of patients analyzed, type of rows of detector elements (1 to 64 detector row), and time from admission to angiography. In addition, the number of TP, FP, FN, and TN for contrast extravasation in diagnosing severe pelvic hemorrhage were collected.…”

Section: Methodsmentioning

confidence: 99%

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

2021

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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.

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“…Although multiphase acquisitions in both arterial and portal venous phase CT have become standard in some trauma centers [ 17 , 18 ], many institutions may still perform CT with a portal venous phase scan only [ 19 ]. In a multicenter study on pelvic trauma performed by Costantini et al, only 15.8% of all patients underwent CT including arterial phase scan [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Do we really need the arterial phase on CT in pelvic trauma patients?

et al. 2020

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Purpose To evaluate whether an arterial phase scan improves the diagnostic performance of computed tomography to identify pelvic trauma patients who received angiographic intervention on demand of the trauma surgeon. Methods This retrospective single-center study was performed at an academic Scandinavian trauma center with approximately 2000 trauma admissions annually. Pelvic trauma patients with arterial and portal venous phase CT from 2009 to 2015 were included. The patients were identified from the institutional trauma registry. Images were interpreted by two radiologists with more than 10 years of trauma radiology experience. Positive findings for extravasation on portal venous phase alone or on both arterial and portal venous phase were compared, with angiographic intervention as clinical outcome. Results One hundred fifty-seven patients (54 females, 103 males) with a median age of 45 years were enrolled. Sixteen patients received angiographic intervention. Positive CT findings on portal venous phase only had a sensitivity and specificity of 62% and 86%, vs. 56% and 93% for simultaneous findings on arterial and portal venous phase. Specificity was significantly higher for positive findings in both phases compared with portal venous phase only. Applying a threshold > 0.9 cm of extravasation diameter to portal venous phase only resulted in sensitivity and specificity identical to those of both phases. Conclusion Arterial phase scan in addition to portal venous phase scan did not improve patient selection for angiography. Portal venous phase extravasation size alone may be used as an imaging-based biomarker of the need for angiographic intervention.

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The role of multidetector computed tomography versus digital subtraction angiography in triaging care and management in abdominopelvic trauma

Cited by 9 publications

References 17 publications

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

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

Do we really need the arterial phase on CT in pelvic trauma patients?

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