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01-08-2008

Acute Management of Hemodynamically Unstable Pelvic Trauma Patients: Time for a Change? Multicenter Review of Recent Practice

Authors: Diederik Verbeek, Michael Sugrue, Zsolt Balogh, Danny Cass, Ian Civil, Ian Harris, Thomas Kossmann, Steve Leibman, Valerie Malka, Anthony Pohl, Sudhakar Rao, Martin Richardson, Michael Schuetz, Caesar Ursic, Vanessa Wills

Published in: World Journal of Surgery | Issue 8/2008

Abstract

Background

Hemorrhage-related mortality (HRM) associated with pelvic fractures continues to challenge trauma care. This study describes the management and outcome of hemodynamically unstable patients with a pelvic fracture, with emphasis on primary intervention for hemorrhage control and HRM.

Methods

Blunt trauma patients [Injury Severity Score (ISS) ≥16] with a major pelvic fracture (Abbreviated Injury Score, pelvis ≥3) and hemodynamic instability [admission systolic blood pressure (SBP) ≤90 mmHg or receiving ≥6 units of packed red blood cells (PRBCs)/24 hours) were included into a 48-month (ending in December 2003) multicenter retrospective study of 11 major trauma centers. Data are presented as the mean ± SD.

Results

A total of 217 patients (mean age 41 ± 19 years, 71% male, ISS 42 ± 16) were studied. The admission SBP was 96 ± 37 mmHg and the Glascow Coma Scale (GCS) 11 ± 5. Patients received 4 ± 2 liters of fluids including 4 ± 4 units of PRBCs in the emergency room (ER). In total, 69 (32%) patients died, among whom the HRM was 19%; 29% of the deaths were due to pelvic bleeding. Altogether, 120 of the 217 (55%) patients underwent focused abdominal sonography for trauma (FAST) or diagnostic peritoneal aspiration (DPA) and diagnostic peritoneal lavage (DPL); 60 of the 217 (28%) patients were found to have pelvic binding in the ER. In all, 53 of 109 (49%) patients had no bleeding noted at laparotomy, 26 of 106 (25%) had no abdominal findings, and 15 of 53 (28%) had had no prior abdominal investigation (FAST/DPL/computed tomography). Angiography was positive in 48 of 58 (83%) patients. The HRM was highest in patients with laparotomy as the primary intervention (29%) followed by the angiography group (18%), the combined laparotomy/pelvic fixation group (16%), and the pelvic fixation-only group (10%).

Conclusion

HRM associated with major pelvic trauma is unacceptably high especially in the laparotomy group. Hence, nontherapeutic laparotomy must be avoided, concentrating instead on arresting pelvic hemorrhage. Standards of care must be implemented and abided by.

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Title: Acute Management of Hemodynamically Unstable Pelvic Trauma Patients: Time for a Change? Multicenter Review of Recent Practice
Authors: Diederik Verbeek
Michael Sugrue
Zsolt Balogh
Danny Cass
Ian Civil
Ian Harris
Thomas Kossmann
Steve Leibman
Valerie Malka
Anthony Pohl
Sudhakar Rao
Martin Richardson
Michael Schuetz
Caesar Ursic
Vanessa Wills
Publication date: 01-08-2008
Publisher: Springer US
Published in: World Journal of Surgery / Issue 8/2008
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-008-9591-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Acute Management of Hemodynamically Unstable Pelvic Trauma Patients: Time for a Change? Multicenter Review of Recent Practice

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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