Haemorrhage control in pelvic fractures—A survey of surgical capabilities

Metcalfe, Andrew; Davies, K.; Ramesh, B.; O'Kelly, Allison; Ramesh, Rajagopal

doi:10.1016/j.injury.2010.11.062

Cited by 20 publications

(14 citation statements)

References 11 publications

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“…4) seems to decrease mortality, at least according to the teams that advise this technique [23][24][25][26]. Pelvic packing is still not widely used (less than 15% of British surgeons know how to perform a retroperitoneal pelvic packing [27]) but a recent publication [28] has shown that the teaching of damage control techniques (including retroperitoneal packing) to rural Norwegian centers is efficient and is capable of saving lives. In France, the current indications for pelvic packing include the two following situations: • appearance or rapid aggravation of pelvic retroperitoneal hemorrhage (RPH) during a laparotomy performed for bleeding visceral trauma, the development of which is related to improved hemodynamics because of the hemostasis thus far performed; • bleeding open pelvic injuries.…”

Section: Principles Of Management Hemostatic Strategymentioning

confidence: 99%

Current management of severe pelvic and perineal trauma

Arvieux

Thony

Broux

et al. 2012

Journal of Visceral Surgery

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Mortality associated with pelvic and perineal trauma (PPT) has fallen from 25% to 10% in the last decade thanks to progress accomplished in medical, surgical and interventional radiology domains (Dyer and Vrahas, 2006) [1]. The management strategy depends on the hemodynamic status of the patient (stable, unstable or extremely unstable). Open trauma requires specific treatment in addition to control of bleeding. All surgical centers can be confronted some day with patients with hemorrhagic PPT and for this reason, all surgeons should be familiar with the initial management. In expert centers, management of patients with severe PPT is complex, multidisciplinary and often requires several re-interventions. Obstetrical and sexual trauma, also requiring specific management, will not be dealt with herein.

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Section: Principles Of Management Hemostatic Strategymentioning

confidence: 99%

Current management of severe pelvic and perineal trauma

Arvieux

Thony

Broux

et al. 2012

Journal of Visceral Surgery

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“…Meanwhile, interventional radiologists are not in-house at all times [3], and interventions are easily to be delayed during nights and weekends [39]. Metcalfe et al reported that a 24 h formal interventional radiology service was only available at 18% of hospitals in Wales, UK [40]. PP is a fast and easy procedure with a low demand for equipment and short learning curve, deserving a more widespread use.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of pelvic packing in hemodynamically unstable patients with pelvic fracture: a meta-analysis

Liu

et al. 2020

Preprint

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Background Pelvic packing (PP) has been increasingly used for bleeding control in severe pelvic trauma. However, its effectiveness remains controversial. This meta-analysis was performed systematically to determine the efficiency of PP in pelvic fracture patients with hemodynamic instability. Methods Three databases, PubMed, Embase and Cochrane Library were systematically searched to identify studies presenting comparisons between protocol including PP and protocol without PP. Mortality, transfusion requirement and length of hospitalization were extracted and pooled for meta-analysis. Relative risk (RR) or standard mean difference (SMD) with their confidence interval (CI) was used for the pooled statistical indexes included mortality, transfusion requirement and length of hospitalization. Results Ten studies involving 560 patients were identified eligible for meta-analysis. A significantly reduced overall mortality (RR = 0.63, 95% CI = 0.50 to 0.79, p < 0.01) as well as reduced mortality within 24 h after admission (RR = 0.42, 95% CI = 0.27 to 0.63, p < 0.01) and due to hemorrhage (RR = 0.27, 95% CI = 0.15 to 0.49, p < 0.01) was shown by PP. The usage of PP also decreased the need for pre-operative transfusion (SMD = -0.44, 95% CI= -0.69 to -0.18, p = 0.001) but had no influence on transfusion during the first 24 h after admission (SMD = 0.04, 95% CI = -0.24 to 0.31, p = 0.215) and length of hospitalization (ICU and total stays). Conclusions This meta-analysis indicates that a treatment protocol including PP significantly reduce mortality and transfusion requirement before intervention in pelvic fracture patients with hemodynamic instability. An algorithm in which pelvic packing is performed as first-line treatment was recommended and complemented with angiography and embolization for patients with traumatic pelvic hemorrhage.

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“…The labor costs per procedure performed by the on-call interventionist were € 459.92. , the "real world scenario" will differ significantly from the above-mentioned recommendation: the authors found a formal OOHR for IR to be installed in 28 % of evaluated hospitals in the London area with 58 % offering an "ad hoc" service for cer- tain but not all interventional procedures. IR coverage for the treatment of bleeding complications from pelvic fractures has been described by other specialities as patchy and often unavailable [15]. To our knowledge, a formal and 24/7 OOHR for IR may exist at certain university hospitals in Germany, but seems to be rare amongst the majority of all German hospitals even with major trauma centers only offering an "ad hoc" service for IR procedures as reported earlier by a Scottish working group [3].…”

mentioning

confidence: 84%

Launching a Permanent Out-of-Hour Interventional Radiology Service: Single-Center Experience from a German University Hospital

Goltz

Janssen

Petritsch

et al. 2013

Fortschr Röntgenstr

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Ziel: Untersuchung der Realisierbarkeit, Einsatzhäufigkeit, Leistungen und Kosten eines formellen "Rund-um-die-Uhr" interventionell-radiologischen (IR) Hintergrunddienstes. Material und Methoden: Im November 2011 wurde ein formeller Hintergrunddienst für IR Leistungen eingeführt. Wir führten eine elektronische Abfrage unseres Dokumentationssystems nach IR Leistungen zwischen 1/2012 und 12/ 2012 ab, die außerhalb der regulären Arbeitszeiten erbracht worden waren. Elektive Fälle, die bis nach Ende der regulären Arbeitszeit andauerten, wurden von der Auswertung ebenso ausgeschlossen wie solche, bei denen der Hintergrunddienst zwar den Eingriff in der Dienstzeit begonnen, das Krankenhaus aber noch nicht verlassen hatte. Bestimmt wurden Art, Häufigkeit und Personalkosten (€/Jahr und Prozedur) des Hintergrunddienstes. Die Nachfrage zuweisender Fachbereiche wurde analysiert. Ergebnisse: Während eines Zeitraums von 12 Monaten wurden die zuständigen Radiologen (n = 3) für 92 Interventionen ins Krankenhaus gerufen. Die Prozeduren umfassten Angiografien zur akuten Blutungskontrolle (n = 36, 39,1 %), Angiografien zur Therapie der akuten Extremitäten-ischämie (n = 25, 27,2 %), perkutane transhepatische Cholangiografien mit Drainage (PTCD) (n = 10, 10,9 %), Angiografien der Viszeralarterien bei non occlusive disease (n = 7, 7,6 %) und andere Interventionen (n = 14, 15,3 %). Die Personalkosten betrugen € 42 312,21 (€ 32 982,60 Bereitschaftspauschale, € 9 329,61 für geleistete Arbeitsstunden). Die Personalkosten pro Prozedur betrugen € 459,92. Zuweiser waren Allgemeinund Viszeralchirurgie (n = 25), Gefäßchirurgie (n = 24), Innere Medizin (n = 21), Herz-/Thoraxchirurgie (n = 9), Unfallchirurgie (n = 5), Urologie (n = 5) und Anästhesie (n = 3). Abstract! Purpose: To evaluate the feasibility, frequency of use, types of intervention and labor costs of a formal round-the-clock interventional radiology oncall service. Materials and Methods: In 11/2011 a formal and permanent out-of-hour interventional radiology rota in addition to the general radiology out-ofhour rota (OOHR) was established. We retrospectively screened the interventional radiology database for procedures completed outside regular working hours, reviewed all interventions and manually selected cases in which the on-call interventionist was called in from home. We determined the type, frequency of use and costs (€/year and procedure) of this service between 1/2012 and 12/2012. The referring physicians' (sub-) specialties were evaluated. Results: During the 12-month period, the on-call interventionists (n = 3) performed 92 procedures OOH. The procedures included angiography and hemorrhage control (n = 36, 39.1 %), angiography and intervention for acute limb ischemia (n = 25, 27.2 %), percutaneous biliary drainage (PTCD) (n = 10, 10.9 %), angiography for non-occlusive ischemia (n = 7, 7.6 %), and other (n = 14, 15.3 %). The total labor costs for the OOHR were € 42,312.21 (€ 32,982.60 lump sum for stand-by, € 9,329.61 for hours spent on procedures). The labor costs per pro...

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Haemorrhage control in pelvic fractures—A survey of surgical capabilities

Cited by 20 publications

References 11 publications

Current management of severe pelvic and perineal trauma

Current management of severe pelvic and perineal trauma

Effectiveness of pelvic packing in hemodynamically unstable patients with pelvic fracture: a meta-analysis

Launching a Permanent Out-of-Hour Interventional Radiology Service: Single-Center Experience from a German University Hospital

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