Diagnostics and early treatment in prehospital and emergency-room phase in suspicious pelvic ring fractures

Schweigkofler, Uwe; Wohlrath, Bernd; Trentsch, H.; Greipel, J.M.; Tamimi, Nihad; Hoffmann, Reinhard; Wincheringer, Dennis

doi:10.1007/s00068-017-0860-0

Cited by 29 publications

(21 citation statements)

References 16 publications

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“…A total of 2,644 studies were screened. Twenty studies met the eligibility criteria and were included [10][11][12][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] in the quality assessment and meta-analysis ( Fig. 1 and S- Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Findings were interpreted by a radiologist [33-35, 39, 41, 43, 45, 46, 49], surgeon [12,33,35,36,42], or an unreported specialist. [10,11,37,38,40,44,47,48] One study [48] focused on an unstable pelvic fracture. GCS: Glasgow coma scale, In-hos: In-hospital, Pre-hos: Pre-hospital, Xp: X-ray picture, CT: Computed tomography, ?…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In two studies, [10,11] it was not clear when the physical examination was performed. For the index test, we evaluated six studies [11,37,38,45,46,48] as having high risk or high concern because the physical examination ndings were retrospectively collected or because the index test was poorly described. For the reference standard, we evaluated nine studies [12, 34-36, 39, 41, 43, 45, 46, 49] as having low risk of bias because the readers of the imaging scans were blinded to the physical examination ndings or because the reference was based on the radiologist's ndings; otherwise, studies were considered to have high risk of bias and high concern in applicability.…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

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Diagnostic Accuracy of Physical Examination for Detecting Pelvic Fractures Among Blunt Trauma Patients: A Systematic Review and Meta-Analysis

Okada

Nishioka

Ohtsuru

et al. 2020

Preprint

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Background: Pelvic fractures are common among blunt trauma patients, and timely and accurate diagnosis can improve patient outcomes. However, it remains unclear whether physical examinations are sufficient in this context. This study aims to perform a systematic review and meta-analysis of studies on the diagnostic accuracy and clinical utility of physical examination for pelvic fracture among blunt trauma patients.Methods: Studies were identified using the MEDLINE, EMBASE, and CENTRAL databases starting from the creation of the database to January 2020. A total of 20 studies (49,043 patients with 8,300 cases [16.9%] of pelvic fracture) were included in the quality assessment and meta-analysis. Two investigators extracted the data and evaluated the risk of bias in each study. The meta-analysis involved a hierarchical summary receiver operating curve (ROC) model to calculate the diagnostic accuracy of the physical exam. Subgroup analysis assessed the extent of between-study heterogeneity. Clinical utility was assessed using decision curve analysis.Results: The median prevalence of pelvic fracture was 10.5% (interquartile range: 5.1–16.5). The pooled sensitivity (and corresponding 95% confidence interval) of the hierarchical summary ROC parameters was 0.859 (0.761–0.952) at a given specificity of 0.920, which was the median value among the included studies. Subgroup analysis revealed that the pooled sensitivity among patients with a Glasgow Coma Scale score ≥ 13 was 0.933 (0.847–0.998) at a given specificity of 0.920. The corresponding value for patients with scores ≤ 13 was 0.761 (0.560–0.932). For threshold probability < 0.01 with 10%–15% prevalence, the net benefit of imaging tests was higher than that of physical examination. Conclusion: Imaging tests should be performed in all trauma patients regardless of findings from physical examination or patients’ levels of consciousness. However, the clinical role of physical examination should be considered given the prevalence and threshold probability in each setting.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

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Diagnostic Accuracy of Physical Examination for Detecting Pelvic Fractures Among Blunt Trauma Patients: A Systematic Review and Meta-Analysis

Okada

Nishioka

Ohtsuru

et al. 2020

Preprint

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“…The main cause of death in pelvic fractures is major bleeding either from fractures or from concomitant injuries. By implementing standardized prehospital and emergency department trauma management strategies (e.g., ATLS®), including non-invasive stabilization of the pelvis (e.g., pelvic binder), as well as aggressive transfusion regimes with early use of blood products and coagulation factors, the rates of severe bleeding and exsanguination in pelvic fractures could be reduced significantly [24][25][26][27][28]. However, the therapeutic treatment of pelvic fractures still depends on both the hemodynamic status and concomitant diseases.…”

Section: Discussionmentioning

confidence: 99%

Associated abdominal injuries do not influence quality of care in pelvic fractures—a multicenter cohort study from the German Pelvic Registry

et al. 2020

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Background: Pelvic fractures are rare but serious injuries. The influence of a concomitant abdominal trauma on the time point of surgery and the quality of care regarding quality of reduction or the clinical course in pelvic injuries has not been investigated yet. Methods: We retrospectively analyzed the prospective consecutive cohort from the multicenter German Pelvic Registry of the German Trauma Society in the years 2003-2017. Demographic, clinical, and operative parameters were recorded and compared for two groups (isolated pelvic fracture vs. combined abdominal/pelvic trauma). Results: 16.359 patients with pelvic injuries were treated during this period. 21.6% had a concomitant abdominal trauma. The mean age was 61.4 ± 23.5 years. Comparing the two groups, patients with a combination of pelvic and abdominal trauma were significantly younger (47.3 ± 22.0 vs. 70.5 ± 20.4 years; p < 0.001). Both, complication (21.9% vs. 9.9%; p < 0.001) and mortality (8.0% vs. 1.9%; p < 0.001) rates, were significantly higher. In the subgroup of acetabular fractures, the operation time was significantly longer in the group with the combined injury (198 ± 104 vs. 176 ± 81 min, p = 0.001). The grade of successful anatomic reduction of the acetabular fracture did not differ between the two groups. Conclusion: Patients with a pelvic injury have a concomitant abdominal trauma in about 20% of the cases. The clinical course is significantly prolonged in patients with a combined injury, with increased rates of morbidity and mortality. However, the quality of the reduction in the subgroup of acetabular fractures is not influenced by a concomitant abdominal injury.

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“…Depending on concomitant injuries and the patientʼs general condition, initial treatment is focused on acute life-saving interventions; only after stabilization of the patient, fractures are treated by osteosynthesis. [2].…”

Section: Intraoperative Imaging In Pelvic Surgerymentioning

confidence: 99%

Intraoperative Imaging in Pelvic Surgery

et al. 2018

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Pelvic fractures may range from highly severe, life-threatening injuries to less acute clinical entities. There are several sub-entities that are summed up as pelvic injuries. Anatomically, there are fractures of the anterior or posterior pelvic ring. Apart from these, there are fractures of the acetabulum that make up about one fifth of all pelvic injuries. The indication for surgical treatment of pelvic ring injuries depends on the type of injury, involvement of anterior and/or posterior elements of the pelvic ring, demands and the general condition of the patient. In acetabular fractures, indications depend on the dislocation of the fracture and of course also the needs of the patient and his general condition. An intraarticular step-off of more than 2 mm is usually considered as an indication for open reduction and osteosynthesis. Usually in all these injuries, a preoperative CT scan is mandatory to allow precise planning of the operative approach and technique. Intraoperatively, the surgeon should be familiar with the acquisition of the 2D standard views, including 2D imaging of the pelvic ring and the acetabulum. These consist of the anteroposterior view for both pelvic ring and acetabular osteosyntheses. For further assessment of pelvic ring treatments, inlet and outlet views are achievable by angulating the C-arm cranially and caudally. To assess aspects of the anterior and posterior column of the acetabulum, iliac oblique views are used. Here, the C-arm is rotated laterally. As evaluation of 2D views can be limited due to anatomy and superposing structures, intraoperative 3D imaging has become common in the last decade. Special C-arms allow the automatic acquisition of large numbers of projections and create CT-like views of the central volume. Although this method has significantly widened the possibilities of intraoperative imaging, some issues remain. Depending on the amount of implants placed in the imaging field, assessment can be seriously impaired due to artefacts caused by the implants. Intraoperative CT imaging promises enhanced image quality for artefacts and allows a considerably larger field of view. The use of radiation-free navigation facilitates implant placement in minimally invasive procedures like screw placement in the sacroiliacal joint or the acetabulum by visualisation of instruments and implants in a pre- or intraoperative 3D data set.

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Diagnostics and early treatment in prehospital and emergency-room phase in suspicious pelvic ring fractures

Cited by 29 publications

References 16 publications

Diagnostic Accuracy of Physical Examination for Detecting Pelvic Fractures Among Blunt Trauma Patients: A Systematic Review and Meta-Analysis

Diagnostic Accuracy of Physical Examination for Detecting Pelvic Fractures Among Blunt Trauma Patients: A Systematic Review and Meta-Analysis

Associated abdominal injuries do not influence quality of care in pelvic fractures—a multicenter cohort study from the German Pelvic Registry

Intraoperative Imaging in Pelvic Surgery

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