The effect of screening for deep vein thrombosis on the prevalence of pulmonary embolism in patients with fractures of the pelvis or acetabulum: a review of 973 patients.

OBJECTIVES: In patients with pelvic or acetabular fractures, to compare the prevalence of pulmonary embolism in a time period without screening for deep vein thrombosis to that seen when a screening protocol was in place. DESIGN: Retrospective. SETTING: County hospital. PATIENTS: All patients with closed fractures of the pelvis or acetabulum treated during the study periods. INTERVENTION: Prophylaxis for deep vein thrombosis was the same for both groups. From November 1, 1997 though November 31, 1999, a screening protocol for deep vein thrombosis was employed using ultrasound and magnetic resonance venography. From January 1, 2000 through December 1, 2001, no screening was used. MAIN OUTCOME MEASUREMENT: Pulmonary emboli were recorded. RESULTS: The 1997 to 1999 time period included 486 patients with fractures of the pelvis or acetabulum; the 2000 to 2001 time period included 487. In the period when a screening protocol was in place, 10 patients (2%) were diagnosed with pulmonary embolism by pulmonary arteriogram, autopsy, or ventilation perfusion scan. All but 2 who were diagnosed with pulmonary embolism had undergone screening for deep vein thrombosis, and none of the screening tests were positive. In the 2000 to 2001 time period, when no screening for deep vein thrombosis was done, 7 patients (1.4%) were diagnosed with pulmonary embolism, by pulmonary arteriogram, autopsy, spiral computed tomography scan, or high clinical suspicion. There was no significant difference between the prevalence of pulmonary embolism seen in 1997 to 1999 and that seen in 2000 to 2001 (P = 0.48). CONCLUSION: Discontinuation of screening for the diagnosis of deep vein thrombosis did not change the rate of pulmonary embolism.

Three-dimensional sonographic evaluation of the common bile duct.

OBJECTIVE: To assess the accuracy of three-dimensional sonographic measurements of the common bile duct compared with standard two-dimensional anteroposterior measurement of the common duct. METHODS: Fifty-five consecutive patients referred for abdominal sonography underwent standard two-dimensional abdominal sonography followed by three-dimensional sonographic data acquisition of the right upper quadrant. A radiologist blinded to the results of the two-dimensional examination later measured the three-dimensional long axis anteroposterior common duct diameter and three-dimensional short axis anteroposterior and transverse common duct diameters. RESULTS: The mean average common duct diameter as measured by two-dimensional sonography (long axis anteroposterior) was 3.6 mm. The mean average common duct diameter as measured by long axis anteroposterior three-dimensional sonography was 4.1 mm. The mean average common duct diameter as measured by anteroposterior short axis three-dimensional sonography was 4.1 mm, and by transverse short axis three-dimensional sonography, it was 4.4 mm. The two-dimensional common duct measurement correlated with the long axis anteroposterior three-dimensional measurement (P < .001), the short axis anteroposterior three-dimensional measurement (P < .001), and the short axis transverse three-dimensional measurement (P < .005) by the Spearman rank order correlation coefficient test. CONCLUSIONS: Three-dimensional sonographic measurements of the common bile duct correlate highly with two-dimensional measurements, validating the use of three-dimensional sonography as a reliable method for evaluation of common bile duct size.

Pelvic ring disruptions: prediction of associated injuries, transfusion requirement, pelvic arteriography, complications, and mortality.

OBJECTIVE: To determine if age, fracture pattern, systolic blood pressure on arrival, base deficit, or the Revised Trauma Score is predictive of mortality, transfusion requirements, use of pelvic arteriography, later complications, or injuries associated with the pelvic ring disruption. STUDY DESIGN: Retrospective review of a prospectively collected database. METHODS: All closed pelvic ring disruptions seen between November 1, 1997 and November 30, 1999 were included. Predictive variables and outcome variables were recorded for each patient. Statistical analysis was used to determine if the above variables were predictive. RESULTS: Shock on arrival and the Revised Trauma Score were significantly associated with mortality, transfusion requirement, Injury Severity Score, and all the Abbreviated Injury Scores except the one for skin. In addition, the Revised Trauma Score was significantly associated with the use of pelvic arteriography and predicted more complications than did shock on arrival. Age was significantly associated with transfusion requirement, Injury Severity Score, the chest and skin Abbreviated Injury Scores, use of arteriography, and death. The mortality rate among patients who presented in shock was 57 percent. A Revised Trauma Score of less than 11 predicted mortality with a sensitivity and specificity of 58 percent and 92 percent, respectively. Shock on arrival predicted mortality with a sensitivity and specificity of 27 percent and 96 percent, respectively. Age greater than sixty years predicted mortality with a sensitivity and specificity of 26 percent and 91 percent, respectively. In our analysis of the fracture patterns, we were unable to demonstrate consistent, meaningful links between specific fracture classes and the outcome variables. CONCLUSIONS: Shock on arrival and the Revised Trauma Score are useful predictors of mortality and transfusion requirements, Injury Severity Score, and Abbreviated Injury Scores for the head and neck, face, chest, abdomen, and extremities. In addition, the Revised Trauma Score predicts the use of pelvic arteriography and later complications. Age predicted transfusion requirement, Injury Severity Score, the chest and skin Abbreviated Injury Scores, use of arteriography, and death.