DIAGNOSTIC POTENTIAL OF THE EARLY IDENTIFICATION OF INTRAPELVIC HEMATOMA BY PLAIN PELVIC X-RAY FOR PREDICTING MASSIVE HEMORRHAGE IN A PRIMARY SURVEY OF PELVIC INJURY

Abstract

　　In primary surveys of initial trauma care, unstable pelvic fractures are examined by pelvic X-rays (PXR) in order to detect possible massive extraperitoneal hemorrhages. In some cases, careful reading of the initial PXRs enables the recognition of intrapelvic hematomas (IPH). We examined the diagnostic ability of PXR to detect IPH and the clinical relevancy of IPH in predicting massive hemorrhages. In 116 pelvic fracture cases encountered between 2007 and 2010, PXR diagnosed IPH with a sensitivity of 80% and a specificity of 89%. They were classified into 2 groups according to the presence of extrapelvic hemorrhagic lesions : the pelvic injury-only group (P group) and the multiple-injury group (M group). In the P group, patients with IPH identified by PXR were significantly more likely to develop hemorrhagic shock during initial care (46% vs.10% ; p<0.01) and needed greater amounts of blood components transfused within 24h of hospital presentation than those without IPHs. Because IPH can be successfully diagnosed by PXR and can predict massive hemorrhage caused by fractures in the anterior portion of the pelvis, early identification of IPH by PXR may contribute to reducing “preventable trauma shock” .