Multidisciplinary Approach for Patients with Pelvic Fractures and Hemodynamic Instability

Stein, Deborah M.; O’Toole, Robert V.; Scalea, Thomas M.

doi:10.1177/145749690709600403

Cited by 39 publications

(26 citation statements)

References 25 publications

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“…1) allows efficient use of our resources and timely intervention for the restoration of haemodynamic stability. Quite a few algorithms have been previously introduced with many similarities with respect to the initial treatment approach of pelvic ring fractures [1,5,[17][18][19][20][21]. Stein et al…”

Section: Discussionmentioning

confidence: 99%

“…The observation that decisions involved the simultaneous input from different subspecialties led to the development of an algorithm so that life-saving actions could be implemented immediately without any arguments or delays. Based on the setup of each trauma unit a protocol is usually developed to accommodate the local resources and manpower [1,[16][17][18]. Whilst there might be minor differences between algorithms, the overall objective remains to achieve the end points of resuscitation, correction of hypovolemia and coagulation disturbances, which could be detrimental in the survival of the traumatised patient.…”

Section: Discussionmentioning

confidence: 99%

“…Their management requires a multidisciplinary approach due to the increased incidence of associated injuries to other body regions and to the intra pelvic organs [1][2][3]. Despite the advances made in all disciplines of medicine the mortality rate following pelvic ring injuries remains as high as 13.5% [2].…”

Section: Introductionmentioning

confidence: 99%

“…Control of bleeding in the early clinical pathway of these traumatised patients is therefore of paramount importance. Temporary stabilisation of the fractured pelvis with binders [1,[4][5][6] or external fixation devices (external fixator, C-clamp) combined with pelvic packing and/or angiography have been used with variable results [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature

Karadimas

Nicolson

Kakagia

et al. 2011

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the relation between pelvic fracture patterns and the angiographic findings, and to assess the effectiveness of the embolisation. Methods This retrospective study, included patients with pelvic fractures and angiographic evaluation. Demographics, Injury Severity Score (ISS), associated injuries, embolisation time, blood units needed, method of treatment and complications were recorded and analysed. Fractures were classified according to the Burgess system. Results Between 1998 and 2008, 34 patients with pelvic fractures underwent angiographic investigation. Twenty six were males. The mean age was 41 years. Twenty-seven were motor vehicle accidents and seven were falls. There were 11 anterior posterior (APC) fractures, 12 lateral compression (LC), eight vertical shear (VS) patterns and three with combined mechanical injuries. The median ISS was 33.1 (range 5-66). From the 34 who underwent angiography, 29 had positive vascular extravasations. From them, 21 had embolisation alone, two had vascular repair and embolisation, five required vascular repair alone and one patient died while being prepared for embolisation. Five cases were re-embolised. The findings suggested that AP fractures have a higher tendency to bleeding compared with LC fractures. Both had a higher chance of blood loss compared to VS and complex fracture patterns. We reported 57 additional injuries and 65 fractures. The complications were: one non lethal pulmonary embolism, one renal failure, one liver failure, one systemic infection, two deep infections and two psychological disorientations. Seven patients died in hospital. Conclusion Control of pelvic fracture bleeding is based on the multidisciplinary approach mainly related to hospital facilities and medical personnel's awareness. The morphology of the fracture did not have a predictive value of the vascular lesion and the respective bleeding.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature

Karadimas

Nicolson

Kakagia

et al. 2011

International Orthopaedics (SICOT)

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“…In jüngster Zeit scheint sich ein Paradigmawechsel mit Annäherung zu vollziehen [5,10]. Der Anteil der arteriellen Blutungen wird auf 10-20% geschätzt.…”

Section: Interventionelle Angiographieunclassified

Verletzungen von Becken und Azetabulum

Rademacher

2011

Trauma Berufskrankh

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Association Between Hemorrhage Control Interventions and Mortality in US Trauma Patients With Hemodynamically Unstable Pelvic Fractures

et al. 2023

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ImportanceManagement of hemodynamically unstable pelvic fractures remains a challenge. Hemostatic interventions are used alone or in combination. There is a paucity of data on the association between the pattern of hemorrhage control interventions and outcomes after a severe pelvic fracture.ObjectiveTo characterize clinical outcomes and study the patterns of hemorrhage control interventions in hemodynamically unstable pelvic fractures.Design, Setting, and ParticipantsIn this cohort study, a retrospective review was performed of data from the 2017 American College of Surgeons Trauma Quality Improvement Program database, a national multi-institutional database of trauma patients in the United States. Adult patients (aged ≥18 years) with pelvic fractures who received early transfusions (≥4 units of packed red blood cells in 4 hours) and underwent intervention for pelvic hemorrhage control were identified. Use and order of preperitoneal pelvic packing (PP), pelvic angioembolization (AE), and resuscitative endovascular balloon occlusion of the aorta (REBOA) in zone 3 were examined and compared against the primary outcome of mortality. The associations between intervention patterns and mortality, complications, and 24-hour transfusions were further examined by backward stepwise regression analyses. Data analyses were performed in September 2021.Main Outcomes and MeasuresPrimary outcomes were rates of 24-hour, emergency department, and in-hospital mortality. Secondary outcomes were major in-hospital complications.ResultsA total of 1396 patients were identified. Mean (SD) age was 47 (19) years, 975 (70%) were male, and the mean (SD) lowest systolic blood pressure was 71 (25) mm Hg. The median (IQR) Injury Severity Score was 24 (14-34), with a 24-hour mortality of 217 patients (15.5%), ED mortality of 10 patients (0.7%), in-hospital mortality of 501 patients (36%), and complication rate of 574 patients (41%). Pelvic AE was the most used intervention (774 [55%]), followed by preperitoneal PP (659 [47%]) and REBOA zone 3 (126 [9%]). Among the cohort, 1236 patients (89%) had 1 intervention, 157 (11%) had 2 interventions, and 3 (0.2%) had 3 interventions. On regression analyses, only pelvic AE was associated with a mortality reduction (odds ratio [OR], 0.62; 95% CI, 0.47 to 0.82; P &lt; .001). Preperitoneal PP was associated with increased odds of complications (OR, 1.39; 95% CI, 1.07 to 1.80; P = .01). Increasing number of interventions was associated with increased 24-hour transfusions (β = +5.4; 95% CI, +3.5 to +7.5; P &lt; .001) and mortality (OR, 1.57; 95% CI, 1.05 to 2.37; P = .03), but not with complications.Conclusions and RelevanceThis study found that among patients with pelvic fracture who received early transfusions and at least 1 invasive pelvic hemorrhage control intervention, more than 1 in 3 died, despite the availability of advanced hemorrhage control interventions. Only pelvic AE was associated with a reduction in mortality.

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Multidisciplinary Approach for Patients with Pelvic Fractures and Hemodynamic Instability

Cited by 39 publications

References 25 publications

Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature

Angiographic embolisation of pelvic ring injuries. Treatment algorithm and review of the literature

Verletzungen von Becken und Azetabulum

Association Between Hemorrhage Control Interventions and Mortality in US Trauma Patients With Hemodynamically Unstable Pelvic Fractures

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