World Journal of Surgery

, Volume 32, Issue 8, pp 1874–1882 | Cite as

Acute Management of Hemodynamically Unstable Pelvic Trauma Patients: Time for a Change? Multicenter Review of Recent Practice

  • Diederik Verbeek
  • Michael Sugrue
  • Zsolt Balogh
  • Danny Cass
  • Ian Civil
  • Ian Harris
  • Thomas Kossmann
  • Steve Leibman
  • Valerie Malka
  • Anthony Pohl
  • Sudhakar Rao
  • Martin Richardson
  • Michael Schuetz
  • Caesar Ursic
  • Vanessa Wills



Hemorrhage-related mortality (HRM) associated with pelvic fractures continues to challenge trauma care. This study describes the management and outcome of hemodynamically unstable patients with a pelvic fracture, with emphasis on primary intervention for hemorrhage control and HRM.


Blunt trauma patients [Injury Severity Score (ISS) ≥16] with a major pelvic fracture (Abbreviated Injury Score, pelvis ≥3) and hemodynamic instability [admission systolic blood pressure (SBP) ≤90 mmHg or receiving ≥6 units of packed red blood cells (PRBCs)/24 hours) were included into a 48-month (ending in December 2003) multicenter retrospective study of 11 major trauma centers. Data are presented as the mean ± SD.


A total of 217 patients (mean age 41 ± 19 years, 71% male, ISS 42 ± 16) were studied. The admission SBP was 96 ± 37 mmHg and the Glascow Coma Scale (GCS) 11 ± 5. Patients received 4 ± 2 liters of fluids including 4 ± 4 units of PRBCs in the emergency room (ER). In total, 69 (32%) patients died, among whom the HRM was 19%; 29% of the deaths were due to pelvic bleeding. Altogether, 120 of the 217 (55%) patients underwent focused abdominal sonography for trauma (FAST) or diagnostic peritoneal aspiration (DPA) and diagnostic peritoneal lavage (DPL); 60 of the 217 (28%) patients were found to have pelvic binding in the ER. In all, 53 of 109 (49%) patients had no bleeding noted at laparotomy, 26 of 106 (25%) had no abdominal findings, and 15 of 53 (28%) had had no prior abdominal investigation (FAST/DPL/computed tomography). Angiography was positive in 48 of 58 (83%) patients. The HRM was highest in patients with laparotomy as the primary intervention (29%) followed by the angiography group (18%), the combined laparotomy/pelvic fixation group (16%), and the pelvic fixation-only group (10%).


HRM associated with major pelvic trauma is unacceptably high especially in the laparotomy group. Hence, nontherapeutic laparotomy must be avoided, concentrating instead on arresting pelvic hemorrhage. Standards of care must be implemented and abided by.


Injury Severity Score Pelvic Fracture Primary Treatment Modality Angiographic Embolization Pelvic Fixation 
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.



We thank the data managers and nursing staff from the Trauma, Orthopedics, and Accident and Emergency departments of all participating hospitals.


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Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Diederik Verbeek
    • 1
  • Michael Sugrue
    • 2
  • Zsolt Balogh
    • 3
  • Danny Cass
    • 4
  • Ian Civil
    • 5
  • Ian Harris
    • 6
  • Thomas Kossmann
    • 7
  • Steve Leibman
    • 8
  • Valerie Malka
    • 9
  • Anthony Pohl
    • 10
  • Sudhakar Rao
    • 11
  • Martin Richardson
    • 12
  • Michael Schuetz
    • 13
  • Caesar Ursic
    • 14
  • Vanessa Wills
    • 3
  1. 1.Trauma DepartmentAcademic Medical CenterAmsterdamThe Netherlands
  2. 2.Trauma DepartmentLiverpool HospitalSydneyAustralia
  3. 3.Trauma DepartmentJohn Hunter HospitalNewcastleAustralia
  4. 4.Institute of Trauma and Injury Management (ITIM)SydneyAustralia
  5. 5.Trauma DepartmentAuckland HospitalGraftonNew Zealand
  6. 6.Department of OrthopaedicsLiverpool HospitalSydneyAustralia
  7. 7.Trauma DepartmentAlfred HospitalPrahranAustralia
  8. 8.Trauma DepartmentRoyal North Shore HospitalSydneyAustralia
  9. 9.Trauma DepartmentWestmead HospitalWestmeadAustralia
  10. 10.Orthopaedics and Trauma DepartmentsRoyal Adelaide HospitalAdelaideAustralia
  11. 11.Trauma DepartmentRoyal Perth HospitalPerthAustralia
  12. 12.Department of OrthopaedicsRoyal Melbourne HospitalParkvilleAustralia
  13. 13.Trauma DepartmentPrincess Alexandra HospitalBrisbaneAustralia
  14. 14.Trauma DepartmentSt. George HospitalSydneyAustralia

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