Pelvic Ring Disruptions: Prediction of Associated Injuries, Transfusion Requirement, Pelvic Arteriography, Complications, and Mortality

Starr, Adam J.; Griffin, Damian R.; Reinert, Charles M.; Frawley, William H.; Walker, Joan; Whitlock, Shelley N.; Borer, Drake S.; Rao, Ashutosh V.; Jones, Alan L.

doi:10.1097/00005131-200209000-00003

Cited by 234 publications

(116 citation statements)

References 28 publications

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“…In general, patients with an injury that increases the bony volume of the pelvis ("open book fractures") are much more likely to have significant bleeding than those with injuries that reduce the volume of the pelvis ("lateral compression fractures") (1). However, severe bleeding can occur in all pelvic fracture patterns, and, unfortunately, there is a poor correlation between the radiologically estimated severity of the pelvic fracture and the need for emergent hemostasis (2,3,10,(15)(16)(17). In children, the incidence of lifethreatening bleeding from pelvic or acetabular fractures seems to be very low (19).…”

Section: Identifying Pelvic Hemorrhagementioning

confidence: 99%

Management of Bleeding Pelvic Fractures

Marzi

Lustenberger

2014

Scand J Surg

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Introduction: in patients with severe pelvic fractures, exsanguinating hemorrhage represents the major cause of death within the first 24 h. despite advances in management, the mortality rate in these patients remains significantly high. recently, multiple treatment algorithms have been proposed for patients with severe pelvic fractures; however, the optimal modalities in particular in the hemodynamically unstable patient are still a matter of lively debate.this review article focuses on the recent body of knowledge on the different treatment options in patients with severe pelvic fractures and proposes the possible role of each modality in the management of these patients.Methods: the Medline database was searched for medical literature addressing the management of severe pelvic fractures with specific attention given to recent, clinically relevant publications.Results: angiography and embolization have emerged as excellent methods for addressing arterial bleeding. Mechanical pelvic stabilization and surgical hemostasis by pelvic packing, on the other hand, may effectively control venous bleeding and bleeding from the fractured bony surface. However, since there is no precise way to determine the major source of bleeding that is responsible for the hemodynamic instability, controversy remains over the timing and optimal order of angiography, mechanical pelvic stabilization, and packing.Conclusions: the author's own approach to these patients includes angiographic embolization as a first-line treatment only in hemodynamically stable patients with an arterial blush seen in the computed tomography scan, indicating acute arterial bleeding. Hemodynamically unstable patients are immediately transferred to the operating room, where pelvic packing and mechanical stabilization of the pelvic ring are carried out. optionally, a subsequent postoperative angio-embolization is performed if signs of further bleeding remain present.

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Section: Identifying Pelvic Hemorrhagementioning

confidence: 99%

Management of Bleeding Pelvic Fractures

Marzi

Lustenberger

2014

Scand J Surg

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“…Revised Trauma Score (RTS) was associated with the use of pelvis angiogram (no report on PFRAB however) in a study by Starr et al [2].…”

Section: Resultsmentioning

confidence: 99%

“…Sensitivity can be increased using dBD>2mmol/L as an adjunct, especially for those patients who have alkalosis on arrival. Base deficit was assessed in only one previous study by Starr et al [2] and was not linked with the use of angiography in their series.…”

Section: Resultsmentioning

confidence: 99%

“…Increasing age was found to predict PFRAB in several studies with cut-off values between 55 and 65 years [2,53,54,75]. This can be due to the older patients' sclerotic vessels poor ability to arrest bleeding with vasospasm or the increased chance of antithrombotic or platelet aggregation inhibitor medication.…”

Section: Resultsmentioning

confidence: 99%

“…They represent great challenge to the managing team even in the well prepared, high volume trauma centres. [1,2,3,4,5,6,7,8] The John Hunter Hospital is a state designated peer-verified level 1 trauma centre in NSW, Australia, a primary referral centre for a population of 1.100.000 and area of 130.000km². All severely injured patients, including all high-energy pelvic ring injuries (HE-PRI), are brought to this centre either directly from the accident scene or through referring hospitals.…”

Section: Introductionmentioning

confidence: 99%

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Acute management of high-energy pelvic ring injuries

Tóth¹

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Assessment of Volume of Hemorrhage and Outcome From Pelvic Fracture

et al. 2003

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Hypothesis: Measurement of pelvic hemorrhage on computed tomographic (CT) scans can estimate the pelvic fracture component of total patient blood loss and predict the need for angiography.Design: Retrospective cohort study.Setting: Large level 1 trauma center.Patients: We examined data from 759 consecutive, nonreferral blunt trauma patients who sustained pelvic fracture.Main Outcome Measures: Pelvic-fracture-specific outcomes included estimation of extraperitoneal pelvic hemorrhage volume from emergency department CT scans and determination of arterial injury from angiograms. General patient outcomes determined from medical record review included transfusion requirement, estimated blood loss, and mortality. Subanalysis was performed on subjects with only pelvic fracture as a source of major hemorrhage (derived from discharge International Classification of Diseases, Ninth Revision, Clinical Modification codes).Results: Overall mortality was 96 (13%) of 759 patients. Blood transfusion was given to 418 (55%) patients, and 258 (34%) received 6 or more units in the first 72 hours. Pelvicfracture-related hemorrhage averaged 149 mL (range, 0-1423 mL). Angiography was performed on 163 patients, of whom 113 had arterial injury. Higher pelvic hemorrhage volumes on CT scans were seen in subjects with pelvic arterial injury demonstrated on angiograms (PϽ.001). In subjects without another source of major hemorrhage, pelvic CT hemorrhage volumes were strongly associated with transfusion requirement (PϽ.001). Subjects with large pelvic hemorrhage volumes (Ͼ500 mL) were more likely to have pelvic arterial injury (risk ratio, 4.8; 95% confidence interval, 3.0-7.8; PϽ.001) and require largevolume (Ն6 U) transfusions (risk ratio, 4.7; 95% confidence interval, 1.8-12.3; PϽ.001) than patients with smaller pelvic hemorrhage volumes. Conclusion:Pelvic hemorrhage volumes derived from pelvic CT scans were predictors of the need for pelvic arteriography and transfusions.

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Pelvic Ring Disruptions: Prediction of Associated Injuries, Transfusion Requirement, Pelvic Arteriography, Complications, and Mortality

Cited by 234 publications

References 28 publications

Management of Bleeding Pelvic Fractures

Management of Bleeding Pelvic Fractures

Acute management of high-energy pelvic ring injuries

Assessment of Volume of Hemorrhage and Outcome From Pelvic Fracture

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