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Effects of the establishment of a trauma center and a new protocol on patients with hemodynamically unstable pelvic fractures at a single institution in Korea

  • Min A. Lee
  • Byungchul YuEmail author
  • Jungnam Lee
  • Jae Jeong Park
  • Gil Jae Lee
  • Kang Kook Choi
  • Youngeun Park
  • Jihun Gwak
  • Ahram Han
Original Article
  • 149 Downloads

Abstract

Purpose

The aim of this study was to determine whether the outcomes of patients with hemodynamically unstable pelvic bone fractures changed after the introduction of a protocol including extraperitoneal pelvic packing (EPP) and the establishment of a trauma center.

Methods

We analyzed data of adult patients (≥ 18 years old) with hemodynamically unstable pelvic bone fractures who visited a single trauma center from February 2009 to October 2016. In July 2014, a new protocol for pelvic fractures was implemented, and a trauma center was established. Therefore, patient outcomes were compared by period (period I: pre-protocol vs. period II: post-protocol).

Results

Seventy-nine patients with hemodynamically unstable pelvic bone fractures were recruited. The time to angiographic embolization after arrival at the emergency room decreased significantly in period II when compared to period I (182.9 vs. 268.9 min, respectively, p < 0.001). The time required to intervention, including EPP, also decreased, from 268.9 ± 132.4 min in period I to 141.9 ± 79.9 min in period II (p < 0.001). The overall mortality rate decreased from 47.2% in period I to 23.3% in period II (p = 0.033), and mortality related to hemorrhagic shock in particular, was significantly lowered, from 27.8% in period I to 4.7% in period II (p = 0.009).

Conclusions

The establishment of a trauma center and the implementation of a new protocol that included EPP were effective in the treatment of patients with hemodynamically unstable pelvic fractures.

Keywords

Trauma Fracture Pelvis Protocol 

Abbreviations

ER

Emergency room

OR

Operating room

ICU

Intensive care unit

EPP

Extraperitoneal pelvic packing

ISS

Injury Severity Score

RBC

Red blood cells

AIS

Abbreviated Injury Scale

ATLS

Advanced Trauma Life Support

CT

Computed tomography

GCS

Glasgow Coma Scale

TRISS

Trauma-related Injury Severity Score

AE

Angiographic embolization

Notes

Compliance with ethical standards

Conflict of interest

Min A. Lee, Byungchul Yu, Jungnam Lee, Jae Jeong Park, Gil Jae Lee, Kang Kook Choi, Youngeun Park, Jihun Gwak and Ahram Han declare that there are no conflicts of interest.

Research involve human participants/animals

This research does not involve human participants and/or animals.

Informed consent

Informed consent obtained from subjects.

Role of the funding source

There are no sources of funding in our study.

Ethical standards

The work has been approved by the appropriate ethical committees related to the institution in which it was performed.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Min A. Lee
    • 1
  • Byungchul Yu
    • 1
    Email author
  • Jungnam Lee
    • 1
  • Jae Jeong Park
    • 1
  • Gil Jae Lee
    • 1
  • Kang Kook Choi
    • 1
  • Youngeun Park
    • 1
  • Jihun Gwak
    • 1
  • Ahram Han
    • 1
  1. 1.Department of Trauma SurgeryGachon University Gil Medical CenterIncheonSouth Korea

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