World Journal of Surgery

, Volume 28, Issue 9, pp 904–909 | Cite as

Hemodynamically Unstable Pelvic Fractures: Recent Care and New Guidelines

  • Martin J. Heetveld
  • Ian Harris
  • Glen Schlaphoff
  • Zsolt Balogh
  • Scott K. D’Amours
  • Michael Sugrue
Original Scientific Reports

Abstract

Consistent care of hemodynamically unstable pelvic fracture patients is a major management issue. It was uncertain whether the introduction of newly developed clinical practice guidelines would require much change in current delivery of care at our institution. Assessment of recent care was undertaken and compared with the newly developed evidence-based best practice guidelines. A multidisciplinary project team developed clinical practice guidelines for determination of early optimum management of hemodynamically unstable patients with pelvic fractures. The guidelines recommend a definitive management plan to arrest hemorrhage within 30 minutes. Intra-abdominal hemorrhage should be assessed with diagnostic peritoneal aspiration (DPA) and/or focused assessment with sonography for trauma (FAST). Early noninvasive stabilization of the pelvis followed by angiography within 90 minutes are recommended if intra-abdominal hemorrhage is not found. Recent care was assessed in a historical cohort of patients, identified in a prospectively maintained trauma registry, between June 1999 and December 2001. Investigations, interventions, and times were then compared with the new guidelines. The delivery of care to 30 patients (mortality 37%, mean ISS 37.8 ± 20.9) was studied. Compared with the new guidelines, the abdominal assessment rate with DPA and/or FAST was 53% and early (< 90 minutes) angiography rate was 38%. A form of pelvic external stabilization was applied in 27% of cases. Noninvasive pelvic stabilization was not performed at all. The recent care of hemodynamically unstable pelvic fracture patients was not in line with newly developed guidelines. There is an opportunity to markedly improve the rates of initial assessment of the abdomen, pelvic stabilization, and early angiography.

Keywords

Pelvic Fracture Pelvic Ring Pelvic Trauma Pelvic Hemorrhage Unstable Pelvic Fracture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2004

Authors and Affiliations

  • Martin J. Heetveld
    • 1
  • Ian Harris
    • 2
  • Glen Schlaphoff
    • 3
  • Zsolt Balogh
    • 4
  • Scott K. D’Amours
    • 4
  • Michael Sugrue
    • 4
  1. 1.Trauma Unit, Department of SurgeryAcademic Medical CenterAmsterdamThe Netherlands
  2. 2.Department of OrthopaedicsLiverpool HospitalLiverpool BCAustralia
  3. 3.Department of Interventional RadiologyLiverpool HospitalLiverpool BCAustralia
  4. 4.Department of TraumaLiverpool HospitalLiverpool BCAustralia

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