Direct retroperitoneal pelvic packing versus pelvic angiography: A comparison of two management protocols for haemodynamically unstable pelvic fractures

Osborn, Patrick M.; Smith, Wade R.; Moore, Ernest E.; Cothren, Clay C.; Morgan, Steven J.; Williams, Allison; Stahel, Philip F.

doi:10.1016/j.injury.2008.08.038

Cited by 229 publications

(223 citation statements)

References 27 publications

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“…Tai and colleagues, 22 commented that retroperitoneal pelvic packing was as clinically effective as angiography and significantly reduced the 140-minute delay to achieving embolization. Similarly, Osborn and colleagues 23 noted a reduction to hemorrhage control within 45 minutes for pelvic packing compared with 130 minutes for angiography. Finally, although door to needle times are inadequately discussed, Cothren and colleagues 24 also advocate routine peritoneal pelvic packing with a combined operative and subsequent angiography time of 164 minutes.…”

Section: Discussionmentioning

confidence: 89%

Timeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?

Smith

Ouellet

Niven

et al. 2013

CJS

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RESEARCH • RECHERCHETimeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?Background: Modern trauma care relies heavily on nonoperative, emergent percutaneous procedures, particularly in patients with splenic, pelvic and hepatic injuries. Unfortunately, specific quality measures (e.g., arrival to angiography times) have not been widely discussed. Our objective was to evaluate the time interval from arrival to initiation of emergent percutaneous procedures in severely injured patients.Methods: All severely injured trauma patients (injury severity score [ISS] > 12) presenting to a level 1 trauma centre (2007)(2008)(2009)(2010) were analyzed with standard statistical methodology.Results: Among 60 severely injured patients (mean ISS 31, hypotension 18%, mortality 12%), the median time interval to the initiation of an angiographic procedure was 270 minutes. Of the procedures performed, 85% were therapeutic embolizations and 15% were diagnostic procedures. Splenic (median time 243 min, range 32-801 min) and pelvic (median time 278 min, range 153-466 min) embolizations accounted for 43% and 25% of procedures, respectively. The median embolization procedure duration for the spleen was 28 (range 15-153) minutes compared with 59 (range 34-171) minutes for the pelvis. Nearly 22% of patients required both an emergent percutaneous and subsequent operative procedure. Percutaneous therapy typically preceded open operative explorations. Conclusion:The time interval from arrival at the trauma centre to emergent percutaneous procedures varied widely. Improved processes emphasizing patient transition from the trauma bay to the angiography suite are essential. Discussion regarding the appropriate time to angiography is needed so this marker can be used as a quality outcome measure for all level 1 trauma centres. Contexte :De nos jours, en traumatologie, les soins reposent largement sur des interventions non chirurgicales percutanées d'extrême urgence, particulièrement chez les patients blessés à la rate, au bassin et au foie. Malheureusement, les indices de qualité spé-cifiques (p. ex., temps écoulé entre l'arrivée et l'angiographie) n'ont pas fait l'objet de discussions approfondies. Notre objectif était de mesurer le temps écoulé entre l'arrivée et l'instauration des interventions percutanées d'extrême urgence chez les grands blessés. Méthodes

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Section: Discussionmentioning

confidence: 89%

Timeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?

Smith

Ouellet

Niven

et al. 2013

CJS

View full text Add to dashboard Cite

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“…Pelvic packing as well as arterial embolization are effective interventions that control bleeding for hemodynamically unstable patients with pelvic fractures. [25,26] However, pelvic packing was not performed in this study, so we did not evaluate the efficacy of pelvic packing in patients with unstable pelvic fractures.…”

Section: Discussionmentioning

confidence: 99%

Pelvic bone fractures associated with intra-abdominal solid organ injury

Kwon¹,

Kim²,

Hong³

et al. 2014

Ulus Travma Acil Cerrahi Derg

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“…[18] Başka bir yayında ise, ekstraperitonal pelvik packing ile anjiyografi karşılaştırılmış ve ikisi arasında mortalite yönün-den anlamlı fark bulunamamıştır. [19] Bizim ise pelvik packing uyguladığımız 5 hastanın 2'si ameliyatta veya ameliyat sonrası erken dönemde, biri ise geç dönem-de sepsisten kaybedildi.…”

Section: Tablounclassified

Factors affecting mortality in multitraumatized patients with pelvic fractures.

Özpek¹,

Yücel²,

Atak³

et al. 2014

J Kartal TR

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ÖzetAmaç: Pelvis kırıkları, yüksek enerjili künt travmalar sonucu oluşur ve yüksek mortaliteyle seyreder. Bu yazıda, künt travmaya bağlı pelvis kırıklarında mortaliteye etki eden faktörler araştırıldı. Sonuç: Multitravmalı hastalarda pelvis kırığının instabil olması, eşlik eden yaralanmaların şiddeti, yüksek ISS, düşük RTS değeri ve artmış transfüzyon gereksiniminin mortaliteyi etkilediği belirlendi.

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Direct retroperitoneal pelvic packing versus pelvic angiography: A comparison of two management protocols for haemodynamically unstable pelvic fractures

Cited by 229 publications

References 27 publications

Timeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?

Timeliness in obtaining emergent percutaneous procedures in severely injured patients: How long is too long and should we create quality assurance guidelines?

Pelvic bone fractures associated with intra-abdominal solid organ injury

Factors affecting mortality in multitraumatized patients with pelvic fractures.

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