Purpose: In patients with pelvic trauma, the need to quickly and accurately rule out sources of bleeding is paramount. We sought to determine the predictive value of CT angiography in determining the need for therapeutic angiography and to ascertain if definable arterial bleeding correlated with anatomic injury.

Method: Over a 2 year period 58 patients with a high-energy mechanism and pelvic injury underwent pelvic CT angiography as part of their initial trauma CT scan. This was performed as a 25 second delayed scan (after contrast introduction) using a GE light speed VCT64 scanner. The decision to proceed to therapeutic angiography was made on clinical grounds and was later compared with the CT angiographic findings. The anatomic location of bleeding on CT angio and interventional angio were compared.

Results: There were 36 male and 22 female patients, aged 43 (17 – 86), with average ISS of 18.6. The 18 (31%) patients with positive extravasation on CT angiography had higher initial blood requirements compared to those without extravasation. Two of the CT(+) group died prior to therapeutic angiography being performed. 11 of the remaining 16 had interventional angiography; 8 had (+) findings, including 7 major vessels coiled and 1 cutoff vessel observed. 1 patient of 40 with negative CT angiogram met clinical criteria had an interventional angiography; no arterial bleeding was discovered. The negative predictive value of CT angiography for pelvic arterial bleeding requiring therapeutic angiography was 100%; the positive predictive value of angiographically treatable bleeding was 70% (counting the two early deaths). The vessel location on CT angio and therapeutic angio was consistent in all cases. The CT angio (+) group had a higher percentage of unstable pelvic injuries (67% vs. 40%).

Conclusion: In this pilot study, CT angiography added to the initial trauma scan in patients with pelvic trauma demonstrated a 100% NPV for arterial bleeding that required therapeutic angiography on clinical grounds. Positive findings correlated well with the anatomic location of pelvic injury and had a 70% PPV for angio-graphically treatable bleeding. Further study of this technique is warranted.

We aimed to quantify the sample sizes and magnitude of treatment effects in a review of orthopaedic randomised trials with statistically significant findings.

We conducted a comprehensive search (PubMed, Cochrane) for all randomised controlled trials between 1/1/95 to 12/31/04. For continuous outcome measures (ie functional scores), we calculated effect sizes (mean difference/standard deviation). Dichotomous variables (ie infection, nonunion) were summarised as absolute risk differences and relative risk reductions (RRR). Effect sizes > 0.80 and RRRs> 50% were defined as large effects.

Our search yielded 433 RCTs, of which 76 RCTs with statistically significant findings on 184 outcomes (122 continuous/62 dichotomous outcomes) met study eligibility criteria. The mean effect size across studies with continuous outcome variables was 1.7 (95% confidence interval: 1.43–1.97). Almost one in three results, despite being reported as statistically significant did meet the definition of a large effect size (ES< 0.80). For dichotomous outcomes, the mean risk difference was 30% (95%confidence interval:24%–36%) and the mean relative risk reduction was 61%.