Intra-abdominal injury is easily overlooked in the patients with concomitant unstable hemodynamics and pelvic fractures

Chih Yuan Fu, Chien An Liao, Chien Hung Liao, Shih Ching Kang, Shang Yu Wang, Yu Pao Hsu, Being Chuan Lin, Kuo Ching Yuan, I. Ming Kuo, Chun Hsiang Ouyang

Research output: Contribution to journalArticle

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Abstract

Introduction Transcatheter arterial embolization (TAE) is usually necessary in the management of hemodynamically unstable patients with concomitant pelvic fractures. Given the critical conditions of such patients, TAE is at times performed only according to the results of a primary evaluation without computed tomographic (CT) imaging. Therefore, the evaluation of associated intra-abdominal injuries (IAIs) might be insufficient. Clinically, some patients have required post-TAE laparotomy due to further deterioration. In this study, we attempted to determine a feasible protocol for post-TAE observation. Materials and methods This study focused on patients who received TAE to achieve hemostasis of retroperitoneal hemorrhage and who did not undergo CT imaging due to their unstable hemodynamics. The characteristics of patients with and without associated IAIs requiring post-TAE laparotomy were compared. We also analyzed the effects of the timing of post-TAE CT imaging on patients with IAIs requiring surgery. Results A total of 41 patients were enrolled in the study. Of these patients, all of whom underwent primary TAE without preprocedure CT imaging; 15 patients (15/41, 36.6%) required post-TAE laparotomy due to further deterioration. Comparisons between the 2 patient groups revealed no significant differences in the rate of endotracheal intubation (80.0% vs 65.4%, P =.480), loss of consciousness (66.7% vs 73.1%, P =.730), or abdominal symptoms (20.0% vs 23.1%, P = 1.000). Conclusion In the management of hemodynamically unstable patients with concomitant pelvic fractures, greater attention should be paid to associated IAIs. Early CT imaging is encouraged after the patient's hemodynamic status is stabilized with TAE.

Original languageEnglish
Pages (from-to)553-557
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume32
Issue number6
DOIs
Publication statusPublished - Jan 1 2014
Externally publishedYes

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Abdominal Injuries
Hemodynamics
Laparotomy
Intratracheal Intubation
Unconsciousness
Hemostasis

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Intra-abdominal injury is easily overlooked in the patients with concomitant unstable hemodynamics and pelvic fractures. / Fu, Chih Yuan; Liao, Chien An; Liao, Chien Hung; Kang, Shih Ching; Wang, Shang Yu; Hsu, Yu Pao; Lin, Being Chuan; Yuan, Kuo Ching; Kuo, I. Ming; Ouyang, Chun Hsiang.

In: American Journal of Emergency Medicine, Vol. 32, No. 6, 01.01.2014, p. 553-557.

Research output: Contribution to journalArticle

Fu, Chih Yuan ; Liao, Chien An ; Liao, Chien Hung ; Kang, Shih Ching ; Wang, Shang Yu ; Hsu, Yu Pao ; Lin, Being Chuan ; Yuan, Kuo Ching ; Kuo, I. Ming ; Ouyang, Chun Hsiang. / Intra-abdominal injury is easily overlooked in the patients with concomitant unstable hemodynamics and pelvic fractures. In: American Journal of Emergency Medicine. 2014 ; Vol. 32, No. 6. pp. 553-557.
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abstract = "Introduction Transcatheter arterial embolization (TAE) is usually necessary in the management of hemodynamically unstable patients with concomitant pelvic fractures. Given the critical conditions of such patients, TAE is at times performed only according to the results of a primary evaluation without computed tomographic (CT) imaging. Therefore, the evaluation of associated intra-abdominal injuries (IAIs) might be insufficient. Clinically, some patients have required post-TAE laparotomy due to further deterioration. In this study, we attempted to determine a feasible protocol for post-TAE observation. Materials and methods This study focused on patients who received TAE to achieve hemostasis of retroperitoneal hemorrhage and who did not undergo CT imaging due to their unstable hemodynamics. The characteristics of patients with and without associated IAIs requiring post-TAE laparotomy were compared. We also analyzed the effects of the timing of post-TAE CT imaging on patients with IAIs requiring surgery. Results A total of 41 patients were enrolled in the study. Of these patients, all of whom underwent primary TAE without preprocedure CT imaging; 15 patients (15/41, 36.6{\%}) required post-TAE laparotomy due to further deterioration. Comparisons between the 2 patient groups revealed no significant differences in the rate of endotracheal intubation (80.0{\%} vs 65.4{\%}, P =.480), loss of consciousness (66.7{\%} vs 73.1{\%}, P =.730), or abdominal symptoms (20.0{\%} vs 23.1{\%}, P = 1.000). Conclusion In the management of hemodynamically unstable patients with concomitant pelvic fractures, greater attention should be paid to associated IAIs. Early CT imaging is encouraged after the patient's hemodynamic status is stabilized with TAE.",
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T1 - Intra-abdominal injury is easily overlooked in the patients with concomitant unstable hemodynamics and pelvic fractures

AU - Fu, Chih Yuan

AU - Liao, Chien An

AU - Liao, Chien Hung

AU - Kang, Shih Ching

AU - Wang, Shang Yu

AU - Hsu, Yu Pao

AU - Lin, Being Chuan

AU - Yuan, Kuo Ching

AU - Kuo, I. Ming

AU - Ouyang, Chun Hsiang

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Introduction Transcatheter arterial embolization (TAE) is usually necessary in the management of hemodynamically unstable patients with concomitant pelvic fractures. Given the critical conditions of such patients, TAE is at times performed only according to the results of a primary evaluation without computed tomographic (CT) imaging. Therefore, the evaluation of associated intra-abdominal injuries (IAIs) might be insufficient. Clinically, some patients have required post-TAE laparotomy due to further deterioration. In this study, we attempted to determine a feasible protocol for post-TAE observation. Materials and methods This study focused on patients who received TAE to achieve hemostasis of retroperitoneal hemorrhage and who did not undergo CT imaging due to their unstable hemodynamics. The characteristics of patients with and without associated IAIs requiring post-TAE laparotomy were compared. We also analyzed the effects of the timing of post-TAE CT imaging on patients with IAIs requiring surgery. Results A total of 41 patients were enrolled in the study. Of these patients, all of whom underwent primary TAE without preprocedure CT imaging; 15 patients (15/41, 36.6%) required post-TAE laparotomy due to further deterioration. Comparisons between the 2 patient groups revealed no significant differences in the rate of endotracheal intubation (80.0% vs 65.4%, P =.480), loss of consciousness (66.7% vs 73.1%, P =.730), or abdominal symptoms (20.0% vs 23.1%, P = 1.000). Conclusion In the management of hemodynamically unstable patients with concomitant pelvic fractures, greater attention should be paid to associated IAIs. Early CT imaging is encouraged after the patient's hemodynamic status is stabilized with TAE.

AB - Introduction Transcatheter arterial embolization (TAE) is usually necessary in the management of hemodynamically unstable patients with concomitant pelvic fractures. Given the critical conditions of such patients, TAE is at times performed only according to the results of a primary evaluation without computed tomographic (CT) imaging. Therefore, the evaluation of associated intra-abdominal injuries (IAIs) might be insufficient. Clinically, some patients have required post-TAE laparotomy due to further deterioration. In this study, we attempted to determine a feasible protocol for post-TAE observation. Materials and methods This study focused on patients who received TAE to achieve hemostasis of retroperitoneal hemorrhage and who did not undergo CT imaging due to their unstable hemodynamics. The characteristics of patients with and without associated IAIs requiring post-TAE laparotomy were compared. We also analyzed the effects of the timing of post-TAE CT imaging on patients with IAIs requiring surgery. Results A total of 41 patients were enrolled in the study. Of these patients, all of whom underwent primary TAE without preprocedure CT imaging; 15 patients (15/41, 36.6%) required post-TAE laparotomy due to further deterioration. Comparisons between the 2 patient groups revealed no significant differences in the rate of endotracheal intubation (80.0% vs 65.4%, P =.480), loss of consciousness (66.7% vs 73.1%, P =.730), or abdominal symptoms (20.0% vs 23.1%, P = 1.000). Conclusion In the management of hemodynamically unstable patients with concomitant pelvic fractures, greater attention should be paid to associated IAIs. Early CT imaging is encouraged after the patient's hemodynamic status is stabilized with TAE.

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