Management of hemorrhage in severe pelvic injuries

Jeske, Hans-Christian, Larndorfer, Renate, Krappinger, Dietmar, Attal, Rene, Klingensmith, Michael, Lottersberger, Clemens, Dunser, Martin W., Blauth, Michael, Falle, Sven Thomas and Dallapozza, Christian (2010) Management of hemorrhage in severe pelvic injuries. The Journal of Trauma: Injury, Infection, and Critical Care, 68 2: 415-420. doi:10.1097/TA.0b013e3181b0d56e


Author Jeske, Hans-Christian
Larndorfer, Renate
Krappinger, Dietmar
Attal, Rene
Klingensmith, Michael
Lottersberger, Clemens
Dunser, Martin W.
Blauth, Michael
Falle, Sven Thomas
Dallapozza, Christian
Title Management of hemorrhage in severe pelvic injuries
Journal name The Journal of Trauma: Injury, Infection, and Critical Care   Check publisher's open access policy
ISSN 0022-5282
Publication date 2010-02
Sub-type Article (original research)
DOI 10.1097/TA.0b013e3181b0d56e
Volume 68
Issue 2
Start page 415
End page 420
Total pages 6
Place of publication Baltimore, MD, United States
Publisher Lippincott Williams & Wilkins
Collection year 2011
Language eng
Formatted abstract
Background:
Major pelvic trauma results in high mortality. No standard technique to control pelvic hemorrhage has been identified. Methods: In this retrospective study, the clinical course of hemodynamically instable trauma patients with pelvic fractures treated according to an institutional algorithm focusing on basic radiologic diagnostics, external fixation, and early angiographic embolization was evaluated. Study variables included demographics, data on the type and extent of injury, achievement of time from admission to hemorrhage control, complications of angiography, red blood cell needs, and outcome. Standard statistical tests were used. 

Results:

Of 1,476 pelvic fracture patients, 45 fulfilled the inclusion criteria. Two patients presented with severe intra-abdominal hemorrhage and underwent emergency laparotomy with pelvic packing. Forty-two patients underwent angiographic embolization before (n = 24) or after (n = 18) a computed tomography scan. Applying the clinical algorithm, pelvic hemorrhage was controlled in all but one patient who died before any intervention could be initiated (97.8%). The hourly need for red blood cell transfusions decreased during 24 hours after angiographic embolization when compared with before the procedure (3.7 ± 3.5 vs. 0.1 ± 0.1 U/h; p < 0.001). In patients undergoing angiographic embolization, the mean time to hemorrhage control was 163 minutes ± 83 minutes. Hospital mortality was 26.2%. Two patients required reembolization because of hemorrhage from other than the primary bleeding site. One patient developed gluteal necrosis, and nine subsequently required renal replacement therapy.

Conclusion:

Application of a clinical algorithm focusing on basic radiologic diagnostics, external fixation, and early angiographic embolization was effective and safe to rapidly control hemorrhage in hemodynamically instable trauma patients with pelvic fractures.
Copyright © 2010 by Lippincott Williams & Wilkins.
Keyword Pelvic trauma
Algorithm
External fixation
Angiographic embolization
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Medicine Publications
 
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Created: Sun, 28 Feb 2010, 00:03:18 EST