Effect of door-to-angioembolization time on mortality in pelvic fracture: Every hour of delay counts

Lee

2018

BMC Surg

BackgroundBlunt pelvic injuries are often associated with pelvic fractures and injuries to the rectum and genitourinary tract. Pelvic fractures can lead to life-threatening hemorrhage, which is a common cause of morbidity and mortality in trauma. Thus, early identification of patients with pelvic fractures at risk severe bleeding requiring urgent hemorrhage control is crucial. This study aimed to investigate early factors predicting the need for hemorrhage control in blunt pelvic trauma.MethodsThe medical records of 1760 trauma patients were reviewed retrospectively between January 2013 and June 2018. We enrolled 187 patients with pelvic fracture due to blunt trauma who were older than 15 years. The pelvic fracture pattern was classified according to the Orthopedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen (OTA/AO) classification. A multivariate logistic regression model was used to determine independent predictors of the need for pelvic hemorrhage control intervention.ResultsThe most common pelvic fracture pattern was type A (54.5%), followed by types B (36.9%) and C (8.6%). Of 187 patients, 48 (25.7%) required pelvic hemorrhage control intervention. Hemorrhage control interventions were most frequently performed in patients with type B fractures (54.2%). Multivariate logistic regression analysis revealed that type B (odds ratio [OR] = 4.024, 95% confidence interval [CI] = 1.666–9.720, p = 0.002) and C (OR = 7.077, 95% CI = 1.781–28.129, p = 0.005) fracture patterns, decreased body temperature (OR = 2.275, 95% CI = 0.134–0.567, p < 0.001), and elevated serum lactate level (OR = 1.234, 95% CI = 1.061–1.435, p = 0.006) were factors predicting the need for hemorrhage control intervention in patients with blunt pelvic trauma.ConclusionPatients with type B and C fracture patterns on the OTA/AO classification, hypothermia, or an elevated serum lactate level are at risk for bleeding and require pelvic hemorrhage control intervention.Electronic supplementary materialThe online version of this article (10.1186/s12893-018-0438-8) contains supplementary material, which is available to authorized users.

Section: Discussionmentioning

confidence: 99%

Factors predicting the need for hemorrhage control intervention in patients with blunt pelvic trauma: a retrospective study

Lee

2018

BMC Surg

“…Balogh et al noted that patients with pelvic fractures and unstable haemodynamics should receive TAE within 90 min after admission, as this reduces blood transfusion volumes and mortality [29]. Any delay exposes patients to unnecessary risks [28][29][30]. Therefore, early access to angiography is associated with reduced mortality.…”

Section: Discussionmentioning

confidence: 99%

Transarterial embolisation is associated with improved survival in patients with pelvic fracture: propensity score matching analyses

Jeon

Eur J Trauma Emerg Surg

et al. 2020

Introduction Transarterial embolisation (TAE) is an effective intervention for management of arterial haemorrhage associated with pelvic fracture. However, its effects on survival and clinical outcomes are unclear. Methods Trauma patients with survival data between November 2015 and December 2019 were identified using a trauma database. Patients were divided between TAE and non-TAE groups, and a propensity score was developed using multivariate logistic regression. Survival at 28 days was compared between the groups after propensity score matching. Results Among 881 patients included in this study, 308 (35.0%) were treated with TAE. After propensity score matching, 130 pairs were selected. Survival at 28 days was significantly higher among patients treated with TAE than among those treated without TAE [122 (93.9%) vs. 112 (86.2%); odds ratio = 2.45; 95% CI 1.02–5.86; p = 0.039]. Conclusions TAE use was associated with improved survival at 28 days in patients with pelvic fracture and should therefore be considered in the management of severely injured patients with pelvic fracture.

“…Assessment of the source of bleeding is essential in haemodynamically unstable patients to guide treatment in our institution. Ruling out abdominal bleeding quickly with an extended focused assessment with sonography for trauma (e-FAST) or Diagnostic Peritoneal Aspirate (DPA) in haemodynamically unstable patients is common practice guiding rapid decision-making regarding patient destination from the Emergency Department and the need for a trauma laparotomy ( 33 , 34 ). A chest x-ray or e-FAST should be performed to assess for intrathoracic bleeding.…”

Section: Managementmentioning

confidence: 99%

“…The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) is also a controversial temporising measure to manage haemorrhagic shock prior to gaining definitive haemostasis which requires access to the operating theatre and interventional radiology (which can sometimes take time to activate) ( 32 , 39 ). Temporary fracture stabilisation, angioembolisation, and extraperitoneal packing (EPP) are used to manage the haemorrhagic phase for patients with pelvic ring fractures ( 22 , 32 – 34 , 40 – 42 ), however the technique and the order in which they are applied is determined by the surgeon, resources, and institution. In addition to these management options soft tissue injuries to the perineum, genitals, bladder, and bowel need to be considered and managed in patients with open pelvic fractures, complicating the treatment, and decision making in this group of patients.…”

Section: Managementmentioning

confidence: 99%

The Road to Survival for Haemodynamically Unstable Patients With Open Pelvic Fractures

Watkins

Hsu

2020

Front. Surg.

Management of haemodynamically unstable pelvic ring injuries has been simplified into treatment algorithms to streamline care and emergent decision making in order to improve patient outcomes whilst decreasing mortality and morbidity. Pelvic ring injuries are most commonly a result of high-velocity and energy forces that exert trauma to the pelvic bones causing not only damage to the bone but the surrounding soft-tissue, organs, and other structures and are usually accompanied by injuries to other parts of the body resulting in a polytraumatised patient. Open pelvic fractures are a rare subset of pelvic ring fractures that are on the more severe end of the pelvic fracture continuum and usually produce uncontrolled haemorrhage from fractured bone, retroperitoneal haematomas, intraabdominal bleeding from bowel injury, soft tissue injuries to the anus, perineum, and genitals, fractures of the pelvic bones, causing bleeding from cancellous bone, venous, and arterial injuries combined with bleeding from concomitant injuries. This is a very complex and challenging clinical situation and timely and appropriate decisions and action are paramount for a positive outcome. Consequently, open pelvic fractures have an extremely high rate of mortality and morbidity and outcomes remain poor, despite evidence-based improvements in treatment, knowledge, and identification of haemorrhage; in the pre-hospital, critical care, and operative settings. In the future utilisation of haemostatic drugs, dressings, devices, and procedures may aid in the time to haemorrhage control.