Institutional Practice Guidelines on Management of Pelvic Fracture-Related Hemodynamic Instability: Do They Make a Difference?

Balogh, Zsolt J.; Caldwell, Erica; Heetveld, Martin J.; D’Amours, Scott; Schlaphoff, Glen; Harris, Ian A.; Sugrue, Michael

doi:10.1097/01.ta.0000158251.40760.b2

Cited by 139 publications

(113 citation statements)

References 37 publications

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“…12 A higher mortality rate was seen in the APC (20%) and CM (18%) patterns than in the LC (7%) and VS (30%) patterns. 15 It is interesting to note that we used angioembolisation in only high grade displacements as in our cohort of patients, four (57%) had a APC III injury pattern and three (43%) had a LC III injury pattern ( Table I).…”

Section: Discussionmentioning

confidence: 99%

The role of interventional angiography and embolisation in the management of high-energy pelvic ring injuries with uncontrolled haemorrhage

et al. 2017

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Section: Discussionmentioning

confidence: 99%

The role of interventional angiography and embolisation in the management of high-energy pelvic ring injuries with uncontrolled haemorrhage

et al. 2017

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“…2 Modern trauma care relies heavily on nonoperative, emergent percutaneous techniques in the management of injured patients with substantial hemorrhage, particularly in patients with splenic, pelvic and hepatic injuries. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Furthermore, the American College of Surgeons Committee on Trauma states that both level I and II trauma centres should have timely availability to conventional angiography and to radiology staff with the ability to oversee therapeutic procedures. 18 Unfortunately, general consensus guidelines are not currently available to define "timeliness" for percutaneous procedures aimed at hemorrhage control.…”

Section: Discussionmentioning

confidence: 99%

Timeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?

Smith

Ouellet

Niven

et al. 2013

CJS

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RESEARCH • RECHERCHETimeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?Background: Modern trauma care relies heavily on nonoperative, emergent percutaneous procedures, particularly in patients with splenic, pelvic and hepatic injuries. Unfortunately, specific quality measures (e.g., arrival to angiography times) have not been widely discussed. Our objective was to evaluate the time interval from arrival to initiation of emergent percutaneous procedures in severely injured patients.Methods: All severely injured trauma patients (injury severity score [ISS] > 12) presenting to a level 1 trauma centre (2007)(2008)(2009)(2010) were analyzed with standard statistical methodology.Results: Among 60 severely injured patients (mean ISS 31, hypotension 18%, mortality 12%), the median time interval to the initiation of an angiographic procedure was 270 minutes. Of the procedures performed, 85% were therapeutic embolizations and 15% were diagnostic procedures. Splenic (median time 243 min, range 32-801 min) and pelvic (median time 278 min, range 153-466 min) embolizations accounted for 43% and 25% of procedures, respectively. The median embolization procedure duration for the spleen was 28 (range 15-153) minutes compared with 59 (range 34-171) minutes for the pelvis. Nearly 22% of patients required both an emergent percutaneous and subsequent operative procedure. Percutaneous therapy typically preceded open operative explorations. Conclusion:The time interval from arrival at the trauma centre to emergent percutaneous procedures varied widely. Improved processes emphasizing patient transition from the trauma bay to the angiography suite are essential. Discussion regarding the appropriate time to angiography is needed so this marker can be used as a quality outcome measure for all level 1 trauma centres. Contexte :De nos jours, en traumatologie, les soins reposent largement sur des interventions non chirurgicales percutanées d'extrême urgence, particulièrement chez les patients blessés à la rate, au bassin et au foie. Malheureusement, les indices de qualité spé-cifiques (p. ex., temps écoulé entre l'arrivée et l'angiographie) n'ont pas fait l'objet de discussions approfondies. Notre objectif était de mesurer le temps écoulé entre l'arrivée et l'instauration des interventions percutanées d'extrême urgence chez les grands blessés. Méthodes

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“…전 체 골반환 손상의 70%-80%는 낙상 등에 의한 저에너지 손 상으로 20%-30%는 고에너지 손상에 의해 유발되고 고에너 지 골절 시 동반 손상으로서 골반 내 장기, 비뇨생식기, 신 경 혈관 손상이 많으며 주요 사망의 원인은 혈관 손상에 의한 골반 내 출혈이다 7,19) . 최근 진단 및 치료 기법이 발 전함에 따라 사망률이 감소하고 있으며 2,9,14) , 이에 따라 골 절 치료뿐만 아니라 향후 회복 정도에 대한 평가의 중요성 이 증가하게 되었다. 고에너지 손상으로 인한 골반환 손상 에서는 혈역학적으로 불안정하거나 의식이 없는 경우가 발 생하므로 신경 손상의 정도를 초기에 평가하기가 어려워 간과되거나 지연되어 발견되는 경우가 있다.…”

Section: 서 론unclassified

Neurologic Injury within Pelvic Ring Injuries

et al. 2014

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Purpose:To evaluate the incidence of neurologic injury in pelvic ring injuries and to assess the risk factors for neurologic injury related to pelvic fractures. Materials and Methods: Sixty-two patients with the pelvic ring injury were enrolled in the study from March 2010 to May 2013. When the neurologic injury was suspected clinically, the electro-diagnostic tests were performed. Combined injuries, fracture types, and longitudinal displacements were examined for correlations with the neurologic injury. Results: There were 7 cases of AO/OTA type A, 37 cases of type B, and 18 cases of type C. Among them, 25 patients (40%) had combined spine fractures, and the average of longitudinal displacement was 7 mm (1-50 mm). Of the 62 patients, 13 (21%) had neurologic injury related with pelvic fractures; 5 with lumbosacral plexus injury, 5 with L5 or S1 nerve injury, 2 with obturator nerve injury, and 1 case of lateral femoral cutaneous nerve injury. There were no relationships between the neurologic injuries and fracture types (p=0.192), but the longitudinal displacements of posterior ring and combined spine fractures were related to the neurologic injury within pelvic ring injury (p=0.006, p=0.048). Conclusion:The incidence of neurologic injury in pelvis fracture was 21%. In this study, the longitudinal displacements of posterior ring and combined spine fractures were risk factors for neurological injury in pelvic ring injury.

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Institutional Practice Guidelines on Management of Pelvic Fracture-Related Hemodynamic Instability: Do They Make a Difference?

Cited by 139 publications

References 37 publications

The role of interventional angiography and embolisation in the management of high-energy pelvic ring injuries with uncontrolled haemorrhage

The role of interventional angiography and embolisation in the management of high-energy pelvic ring injuries with uncontrolled haemorrhage

Timeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?

Neurologic Injury within Pelvic Ring Injuries

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