Angiographic embolization for pelvic fractures in older patients

Abstract

Hypothesis: Old age predicts reliably the presence of pelvic bleeding, requiring angiographic embolization (AE) among blunt trauma patients with major pelvic fractures.

Design: Four-year prospective observational study (April 1, 1999, to May 31, 2003).

Setting: Academic level I trauma center practicing AE liberally.

Patients: Regardless of hemodynamic stability or the absence of a blood transfusion, patients with major pelvic fractures or significant pelvic hematomas on computed tomography were offered pelvic angiography with the intent to embolize.

Main outcome measure: Angiographically confirmed pelvic bleeding, resulting in AE.

Results: Of 92 patients who underwent pelvic angiography, 55 (60%) had bleeding found on angiography and underwent AE. Patients 60 years and older had a higher likelihood than younger patients to have bleeding identified and to undergo AE (16 [94%] of 17 patients vs 39 [52%] of 75 patients; P<.001). An age of 60 years or older was the only independent predictor of the need for AE. Of patients in this age group, two thirds had normal vital signs on hospital admission. Bleeding was controlled by AE in all patients (100% efficacy).

Conclusions: Among blunt trauma patients with significant pelvic fractures, those 60 years and older have a high likelihood of active retroperitoneal bleeding. Angiographic embolization should be offered liberally to patients in this age group, regardless of presumed hemodynamic stability.