Skip to main content

Improvement of outcomes in patients with pelvic fractures and hemodynamic instability after the establishment of a Korean regional trauma center



Despite using a multidisciplinary treatment approach, the mortality rate of patients with hemodynamic instability from severe pelvic fractures is still 40–60%. We evaluated the improvement of outcomes in this patient population after the establishment of a regional trauma center in Korea.


We retrospectively reviewed the medical charts of 50 patients with hemodynamic instability due to pelvic fractures between March 2011 and November 2016. Patients were divided into two groups: the pre-trauma center (PTC) group (n = 23) and trauma center (TC) group (n = 27).


Sixteen (32.0%) patients died of exsanguination. Patients in the TC group had shorter trauma resuscitation room stay (101 vs 273 min, p < 0.001) and underwent preperitoneal pelvic packing (PPP) more frequently (88.9 vs 8.7%, p < 0.001) than those in the PTC group. During the TC period, emergent procedures such as PPP and pelvic angiography were performed more frequently (92.6 vs 39.1%, p < 0.001). Although there was no statistical difference in the overall mortality rate between groups, patients in the TC group had less mortality due to hemorrhage (18.5 vs 47.8%, p = 0.027). Logistic regression analysis demonstrated that initial systolic blood pressure and establishment of trauma center were independent protective factors of mortality from hemorrhage [odds ratio (OR) 0.957, 95% confidence interval (CI) 0.926–0.988, p = 0.007; OR 0.134, 95% CI 0.028–0.633, p = 0.011].


Since the regional trauma center was established, emergent procedures such as pelvic angiography and PPP were performed more frequently, and mortality due to exsanguination was significantly decreased.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. 1.

    Kim Y, Jung KY, Cho KH, Kim H, Ahn HC. Preventable trauma deaths rates and management errors in emergency medical system in Korea. J Korean Soc Emerg Med. 2006;17:385–94.

    Google Scholar 

  2. 2.

    Kim H, Jung KY, Kim SP, Kim SH, Noh H, Jang HY, et al. Changes in preventable death rates and traumatic care systems in Korea. J Korean Soc Emerg Med. 2012;23(2):189–97.

    Google Scholar 

  3. 3.

    Jung K, Huh Y, Lee JC, Kim Y, Moon J, Youn SH, et al. Reduced mortality by physician-staffed HEMS dispatch for adult blunt trauma patients in Korea. J Korean Med Sci. 2016;31(10):1656–61.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Costantini TW, Coimbra R, Holcomb JB, Podbielski JM, Catalano R, Blackburn A, et al. Current management of hemorrhage from severe pelvic fractures: results of an American Association for the Surgery of Trauma multi-institutional trial. J Trauma Acute Care. 2016;80(5):717–23.

    Article  CAS  Google Scholar 

  5. 5.

    Sathy AK, Starr AJ, Smith WR, Elliott A, Agudelo J, Reinert CM, et al. The effect of pelvic fracture on mortality after trauma: an analysis of 63,000 trauma patients. J Bone Joint Surg Am. 2009;91a(12):2803–10.

    Article  Google Scholar 

  6. 6.

    Mucha P, Welch TJ. Hemorrhage in major pelvic fractures. Surg Clin N Am. 1988;68(4):757–73.

    Article  PubMed  Google Scholar 

  7. 7.

    ONeill PA, Riina J, Sclafani S, Tornetta P. Angiographic findings in pelvic fractures. Clin Orthop Relat R. 1996;329:60–7.

    Article  Google Scholar 

  8. 8.

    Eastridge BJ, Starr A, Minei JP, O’Keefe GE. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma. 2002;53(3):446–50.

    Article  PubMed  Google Scholar 

  9. 9.

    Giannoudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury. 2004;35(7):671–7.

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Starr AJ, Griffin DR, Reinert CM, Frawley WH, Walker J, Whitlock SN, et al. Pelvic ring disruptions: prediction of associated injuries, transfusion requirement, pelvic arteriography, complications, and mortality. J Orthop Trauma. 2002;16(8):553–61.

    Article  PubMed  Google Scholar 

  11. 11.

    Jang JY, Shim H, Jung PY, Kim S, Bae KS. Preperitoneal pelvic packing in patients with hemodynamic instability due to severe pelvic fracture: early experience in a Korean trauma center. Scand J Trauma Resus. 2016.

    Article  Google Scholar 

  12. 12.

    Cothren CC, Osborn PM, Moore EE, Morgan SJ, Johnson JL, Smith WR. Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift. J Trauma. 2007;62(4):834–9.

    Article  PubMed  Google Scholar 

  13. 13.

    Burlew CC, Moore EE, Smith WR, Johnson JL, Biffl WL, Barnett CC, et al. Preperitoneal pelvic packing/external fixation with secondary angioembolization: optimal care for life-threatening hemorrhage from unstable pelvic fractures. J Am Coll Surgeons. 2011;212(4):628–35.

    Article  Google Scholar 

  14. 14.

    Jang JY, Shim H, Jung PY, Kim S, Bae KS. Preperitoneal pelvic packing prior to pelvic angiography in patients with hemodynamic instability due to severe pelvic fracture: two cases. J Acute Care Surg. 2016;6(1):34–9.

    Article  Google Scholar 

  15. 15.

    Biffl WL, Smith WR, Moore EE, Gonzalez RJ, Morgan SJ, Hennessey T, et al. Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures. Ann Surg. 2001;233(6):843–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Conolly WB, Hedberg EA. Observations on fractures of the pelvis. J Trauma. 1969;9(2):104–11.

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Huittinen VM, Slatis P. Postmortem angiography and dissection of the hypogastric artery in pelvic fractures. Surgery. 1973;73(3):454–62.

    CAS  PubMed  Google Scholar 

  18. 18.

    Burlew CC, Moore EE, Stahel PF, Geddes AE, Pieracci AE, Wagenaar AE, et al. Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. J Trauma Acute Care. 2017;82(2):233–42.

    Article  Google Scholar 

  19. 19.

    Cheng M, Cheung MT, Lee KY, Lee KB, Chan SCH, Wu ACY, et al. Improvement in institutional protocols leads to decreased mortality in patients with haemodynamically unstable pelvic fractures. Emerg Med J. 2015;32(3):214–20.

    Article  PubMed  Google Scholar 

  20. 20.

    Li QH, Dong JL, Yang YL, Wang GD, Wang YH, Liu P et al. Retroperitoneal packing or angioembolization for haemorrhage control of pelvic fractures-Quasi-randomized clinical trial of 56 haemodynamically unstable patients with Injury Severity Score ≥33. Injury. 2016;47(2):395–401.

    Article  PubMed  Google Scholar 

  21. 21.

    Chiara O, di Fratta E, Mariani A, Michaela B, Prestini L, Sammartano F, et al. Efficacy of extra-peritoneal pelvic packing in hemodynamically unstable pelvic fractures, a propensity score analysis. World J Emerg Surg. 2016.

    Article  PubMed  PubMed Central  Google Scholar 

Download references


We thank the staff of all the regional trauma centers in Korea for their enthusiasm and commitment to patient care. The authors confirm that were not in receipt of any grants.

Author information



Corresponding author

Correspondence to Hoon Ryu.

Ethics declarations

Conflict of interest

There are no potential conflicts of interest for each of the authors.

Ethics statement

The present study protocol was reviewed and approved by the institutional review board of Wonju Severance Christian Hospital (Reg. No. CR316111). Informed consent was exempted, because it was a retrospective study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jang, J.Y., Shim, H., Kwon, H.Y. et al. Improvement of outcomes in patients with pelvic fractures and hemodynamic instability after the establishment of a Korean regional trauma center. Eur J Trauma Emerg Surg 45, 107–113 (2019).

Download citation


  • Pelvis
  • Hemorrhage
  • Trauma center
  • Preperitoneal pelvic packing
  • Damage control