Transarterial embolization for intractable oronasal hemorrhage associated with craniofacial trauma: Evaluation of prognostic factors

Cheng Chih Liao, Yu Pao Hsu, Chien Tzung Chen, Yuan Yun Tseng

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

BACKGROUND:: This study analyzed the outcomes for clinical application of transarterial embolization (TAE) to treat intractable posttraumatic oronasal hemorrhage in patients who suffered from craniofacial injuries. METHODS:: The charts and radiologic and operative records of 34 patients from January 2002 to December 2007 were retrospectively reviewed. Inclusion criteria focused on the patients whose intractable posttraumatic oronasal hemorrhage associated with craniofacial trauma required TAE treatment. The patients' survival was correlated with prognostic factors with Spearman's rank correlation coefficients. Wilcoxon signed ranks test was used to analyze the differences between the severity of shock before and after TAE, and Fisher's exact test was used to analyze unvaried factors. RESULTS:: TAE successfully stopped the posttraumatic oronasal hemorrhage in 27 of 34 patients (79.4%). The internal maxillary artery was the most common hemorrhaging vessel requiring embolization. Successful hemostasis by TAE significantly contributed to patient survival (p = 0.001). In addition, higher Glasgow Coma Scale score (≥8) at presentation, lower shock index (calculated as heart rate/systolic blood pressure; ≤1.1 and 0.8, before and after TAE, respectively), and injury severity score ≤32 positively contributed to the patients' higher survival rate (p <0.05). During the acute treatment of posttraumatic oronasal hemorrhage, need for craniotomy was not correlated with patient survival, but need for laparotomy to treat the second abdominal hemorrhagic source decreased the rate of patient survival (p = 0.023). CONCLUSION:: TAE may stop intractable posttraumatic oronasal hemorrhage when conventional packing fails to achieve hemostasis. Glasgow Coma Scale score at presentation, shock index before and after TAE, injury severity score, and need for emergent laparotomy can be used to predict the patient prognosis.

Original languageEnglish
Pages (from-to)827-830
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume63
Issue number4
DOIs
Publication statusPublished - Oct 2007
Externally publishedYes

Fingerprint

Hemorrhage
Wounds and Injuries
Shock
Glasgow Coma Scale
Injury Severity Score
Nonparametric Statistics
Hemostasis
Laparotomy
Survival
Survival Rate
Maxillary Artery
Blood Pressure
Craniotomy
Statistical Factor Analysis
Heart Rate
Outcome Assessment (Health Care)
Therapeutics

Keywords

  • Craniofacial trauma
  • Glasgow Coma Scale
  • Posttraumatic oronasal hemorrhage
  • Shock index
  • Transarterial embolization

ASJC Scopus subject areas

  • Surgery

Cite this

Transarterial embolization for intractable oronasal hemorrhage associated with craniofacial trauma : Evaluation of prognostic factors. / Liao, Cheng Chih; Hsu, Yu Pao; Chen, Chien Tzung; Tseng, Yuan Yun.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 63, No. 4, 10.2007, p. 827-830.

Research output: Contribution to journalArticle

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N2 - BACKGROUND:: This study analyzed the outcomes for clinical application of transarterial embolization (TAE) to treat intractable posttraumatic oronasal hemorrhage in patients who suffered from craniofacial injuries. METHODS:: The charts and radiologic and operative records of 34 patients from January 2002 to December 2007 were retrospectively reviewed. Inclusion criteria focused on the patients whose intractable posttraumatic oronasal hemorrhage associated with craniofacial trauma required TAE treatment. The patients' survival was correlated with prognostic factors with Spearman's rank correlation coefficients. Wilcoxon signed ranks test was used to analyze the differences between the severity of shock before and after TAE, and Fisher's exact test was used to analyze unvaried factors. RESULTS:: TAE successfully stopped the posttraumatic oronasal hemorrhage in 27 of 34 patients (79.4%). The internal maxillary artery was the most common hemorrhaging vessel requiring embolization. Successful hemostasis by TAE significantly contributed to patient survival (p = 0.001). In addition, higher Glasgow Coma Scale score (≥8) at presentation, lower shock index (calculated as heart rate/systolic blood pressure; ≤1.1 and 0.8, before and after TAE, respectively), and injury severity score ≤32 positively contributed to the patients' higher survival rate (p <0.05). During the acute treatment of posttraumatic oronasal hemorrhage, need for craniotomy was not correlated with patient survival, but need for laparotomy to treat the second abdominal hemorrhagic source decreased the rate of patient survival (p = 0.023). CONCLUSION:: TAE may stop intractable posttraumatic oronasal hemorrhage when conventional packing fails to achieve hemostasis. Glasgow Coma Scale score at presentation, shock index before and after TAE, injury severity score, and need for emergent laparotomy can be used to predict the patient prognosis.

AB - BACKGROUND:: This study analyzed the outcomes for clinical application of transarterial embolization (TAE) to treat intractable posttraumatic oronasal hemorrhage in patients who suffered from craniofacial injuries. METHODS:: The charts and radiologic and operative records of 34 patients from January 2002 to December 2007 were retrospectively reviewed. Inclusion criteria focused on the patients whose intractable posttraumatic oronasal hemorrhage associated with craniofacial trauma required TAE treatment. The patients' survival was correlated with prognostic factors with Spearman's rank correlation coefficients. Wilcoxon signed ranks test was used to analyze the differences between the severity of shock before and after TAE, and Fisher's exact test was used to analyze unvaried factors. RESULTS:: TAE successfully stopped the posttraumatic oronasal hemorrhage in 27 of 34 patients (79.4%). The internal maxillary artery was the most common hemorrhaging vessel requiring embolization. Successful hemostasis by TAE significantly contributed to patient survival (p = 0.001). In addition, higher Glasgow Coma Scale score (≥8) at presentation, lower shock index (calculated as heart rate/systolic blood pressure; ≤1.1 and 0.8, before and after TAE, respectively), and injury severity score ≤32 positively contributed to the patients' higher survival rate (p <0.05). During the acute treatment of posttraumatic oronasal hemorrhage, need for craniotomy was not correlated with patient survival, but need for laparotomy to treat the second abdominal hemorrhagic source decreased the rate of patient survival (p = 0.023). CONCLUSION:: TAE may stop intractable posttraumatic oronasal hemorrhage when conventional packing fails to achieve hemostasis. Glasgow Coma Scale score at presentation, shock index before and after TAE, injury severity score, and need for emergent laparotomy can be used to predict the patient prognosis.

KW - Craniofacial trauma

KW - Glasgow Coma Scale

KW - Posttraumatic oronasal hemorrhage

KW - Shock index

KW - Transarterial embolization

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