A Multidisciplinary Approach to Treating Traumatic Pelvic Fractures

Miller, Ramie

doi:10.1002/aorn.12272

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…The utility of shock index for early predicting significant hemorrhage and timely activation of the trauma team and massive transfusion protocol expedites appropriate care to stop the bleeding and thereby improve clinical outcomes [7,[35][36][37].…”

Section: Discussionmentioning

confidence: 99%

Patterns, management, and outcomes of traumatic pelvic fracture: insights from a multicenter study

et al. 2020

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Background: Traumatic pelvic fracture (TPF) is a significant injury that results from high energy impact and has a high morbidity and mortality. Purpose: We aimed to describe the epidemiology, incidence, patterns, management, and outcomes of TPF in multinational level 1 trauma centers. Methods: We conducted a retrospective analysis of all patients with TPF between 2010 and 2016 at two trauma centers in Qatar and Germany. Results: A total of 2112 patients presented with traumatic pelvic injuries, of which 1814 (85.9%) sustained TPF, males dominated (76.5%) with a mean age of 41 ± 21 years. In unstable pelvic fracture, the frequent mechanism of injury was motor vehicle crash (41%) followed by falls (35%) and pedestrian hit by vehicle (24%). Apart from both extremities, the chest (37.3%) was the most commonly associated injured region. The mean injury severity score (ISS) of 16.5 ± 13.3. Hemodynamic instability was observed in 44%. Blood transfusion was needed in one third while massive transfusion and intensive care admission were required in a tenth and a quarter of cases, respectively. Tile classification was possible in 1228 patients (type A in 60%, B in 30%, and C in 10%). Patients with type C fractures had higher rates of associated injuries, higher ISS, greater pelvis abbreviated injury score (AIS), massive transfusion protocol activation, prolonged hospital stay, complications, and mortality (p value < 0.001). Two-thirds of patients were managed conservatively while a third needed surgical fixation. The median length of hospital and intensive care stays were 15 and 5 days, respectively. The overall mortality rate was 4.7% (86 patients). Conclusion: TPF is a common injury among polytrauma patients. It needs a careful, systematic management approach to address the associated complexities and the polytrauma nature.

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Section: Discussionmentioning

confidence: 99%

Patterns, management, and outcomes of traumatic pelvic fracture: insights from a multicenter study

et al. 2020

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“…The utility of shock index for early predicting significant hemorrhage and timely activation of the trauma team and massive transfusion protocol expedites appropriate care to stop the bleed and thereby improves clinical outcomes [7,[35][36][37].…”

Section: Discussionmentioning

confidence: 99%

Patterns, Management and Outcomes of Traumatic Pelvic Fracture: Insights from A Multicenter Study

Abdelrahman

El‐Menyar

Keil

et al. 2020

Preprint

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Background: Traumatic pelvic fracture (TPF) is a significant injury results from high energy impact and has a high morbidity and mortality. Purpose: We aimed to describe the epidemiology, incidence, patterns, management, and outcomes of TPF in multinational level 1 trauma centers. Methods: We conducted a retrospective analysis of all patients with TPF between 2010 and 2016 at two trauma centers in Qatar and Germany. Results: A total of 2112 patients presented with traumatic pelvic injuries, of which 1814 (85.9%) sustained TPF, males dominated (76.5%) with a mean age of 41±21 years. In unstable pelvic fracture, the frequent mechanism of injury was motor vehicle crash (41%) followed by falls (35%) and pedestrian hit by vehicle (24%). Apart from both extremities, chest (37.3%) was the most commonly associated injured region. The mean injury severity score (ISS) of 16.5±13.3. Hemodynamic instability was observed in 44%. Blood transfusion was needed in one third while massive transfusion and intensive care admission were required in a tenth and a quarter of cases, respectively. Tile classification was possible in 1228 patients (type A in 60%, B in 30%, and C in 10%). Patients with type C fractures had higher rates of associated injuries, higher ISS , greater pelvis abbreviated injury score (AIS), massive transfusion protocol activation, prolonged hospital stay, complications, and mortality (p-value <0.001). Two-thirds of patients were managed conservatively while a third needed surgical fixation. The median length of hospital and intensive care stays were 15 and 5 days, respectively. The overall mortality rate was 4.7% (86 patients). Conclusion: TPF is a common injury among polytrauma patients. It needs a careful, systematic management approach to address the associated complexities and the polytrauma nature.

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“…All the above considerations must take into account the possible disadvantages in the transportation of a severely injured patient to the angiographic room [ 57 ]. However, the increasingly widespread use of hybrid OR, where trauma surgeons, orthopedic surgeons, and interventional radiologists can work together, is progressively enabling the simultaneous or alternate performance of the initial assessment, resuscitation, damage control surgery, and endovascular procedures, without the need to transfer the patient to the radiological room or the OR [ 9 ].…”

Section: Treatment For Hemorrhage In Pelvic Fracture: State Of the Artmentioning

confidence: 99%

“…Therefore, pelvic trauma represents an important condition to recognize early, manage, and treat. For this reason, a multidisciplinary approach involving trauma surgeons, orthopedic surgeons, emergency room physicians and interventional radiologists is needed to promptly manage the resuscitation of pelvic trauma patients and ensure the best outcomes, both in terms of time and costs [ 9 ]…”

Section: Introductionmentioning

confidence: 99%

Proposal of standardization of every step of angiographic procedure in bleeding patients from pelvic trauma

et al. 2021

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Trauma accounts for a third of the deaths in Western countries, exceeded only by cardiovascular disease and cancer. The high risk of massive bleeding, which depends not only on the type of fractures, but also on the severity of any associated parenchymal injuries, makes pelvic fractures one of the most life-threatening skeletal injuries, with a high mortality rate. Therefore, pelvic trauma represents an important condition to correctly and early recognize, manage, and treat. For this reason, a multidisciplinary approach involving trauma surgeons, orthopedic surgeons, emergency room physicians and interventional radiologists is needed to promptly manage the resuscitation of pelvic trauma patients and ensure the best outcomes, both in terms of time and costs. Over the years, the role of interventional radiology in the management of patient bleeding due to pelvic trauma has been increasing. However, the current guidelines on the management of these patients do not adequately reflect or address the varied nature of injuries faced by the interventional radiologist. In fact, in the therapeutic algorithm of these patients, after the word “ANGIO”, there are no reports on the different possibilities that an interventional radiologist has to face during the procedure. Furthermore, variations exist in the techniques and materials for performing angioembolization in bleeding patients with pelvic trauma. Due to these differences, the outcomes differ among different published series. This article has the aim to review the recent literature on optimal imaging assessment and management of pelvic trauma, defining the role of the interventional radiologist within the multidisciplinary team, suggesting the introduction of common and unequivocal terminology in every step of the angiographic procedure. Moreover, according to these suggestions, the present paper tries to expand the previously drafted algorithm exploring the role of the interventional radiologist in pelvic trauma, especially given the multidisciplinary setting.

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A Multidisciplinary Approach to Treating Traumatic Pelvic Fractures

Cited by 7 publications

References 19 publications

Patterns, management, and outcomes of traumatic pelvic fracture: insights from a multicenter study

Patterns, management, and outcomes of traumatic pelvic fracture: insights from a multicenter study

Patterns, Management and Outcomes of Traumatic Pelvic Fracture: Insights from A Multicenter Study

Proposal of standardization of every step of angiographic procedure in bleeding patients from pelvic trauma

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