Evolution of a Multidisciplinary Clinical Pathway for the Management of Unstable Patients With Pelvic Fractures

Biffl, Walter L.; Smith, Wade R.; Moore, Ernest E.; Gonzalez, Ricardo J.; Morgan, Steven J.; Hennessey, Theresa A.; Offner, Patrick J.; Ray, Charles E.; Franciose, Reginald J.; Burch, Jon M.

doi:10.1097/00000658-200106000-00015

Cited by 319 publications

(193 citation statements)

References 32 publications

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“…cardiac or renal, but also to the various treatments and therapies. In response to Q5, T2 was thus related to research: in disease studies [30][31][32][33][34][35][36][37], to compare care and coding [38][39][40], but also in monitoring of patients over time and the survival rate [31,[41][42][43][44]. Survival rate forms part of a trajectory concept.…”

Section: Discussionmentioning

confidence: 99%

Patient healthcare trajectory. An essential monitoring tool: a systematic review

Pinaire

Azé

Bringay

et al. 2017

Health Inf Sci Syst

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Background: Patient healthcare trajectory is a recent emergent topic in the literature, encompassing broad concepts. However, the rationale for studying patients' trajectories, and how this trajectory concept is defined remains a public health challenge. Our research was focused on patients' trajectories based on disease management and care, while also considering medico-economic aspects of the associated management. We illustrated this concept with an example: a myocardial infarction (MI) occurring in a patient's hospital trajectory of care. The patient follow-up was traced via the prospective payment system. We applied a semi-automatic text mining process to conduct a comprehensive review of patient healthcare trajectory studies. This review investigated how the concept of trajectory is defined, studied and what it achieves.Methods: We performed a PubMed search to identify reports that had been published in peer-reviewed journals between January 1, 2000 and October 31, 2015. Fourteen search questions were formulated to guide our review. A semi-automatic text mining process based on a semantic approach was performed to conduct a comprehensive review of patient healthcare trajectory studies. Text mining techniques were used to explore the corpus in a semantic perspective in order to answer non-a priori questions. Complementary review methods on a selected subset were used to answer a priori questions.Results: Among the 33,514 publications initially selected for analysis, only 70 relevant articles were semi-automatically extracted and thoroughly analysed. Oncology is particularly prevalent due to its already well-established processes of care. For the trajectory thema, 80% of articles were distributed in 11 clusters. These clusters contain distinct semantic information, for example health outcomes (29%), care process (26%) and administrative and financial aspects (16%). Conclusion:This literature review highlights the recent interest in the trajectory concept. The approach is also gradually being used to monitor trajectories of care for chronic diseases such as diabetes, organ failure or coronary artery and MI trajectory of care, to improve care and reduce costs. Patient trajectory is undoubtedly an essential approach to be further explored in order to improve healthcare monitoring.

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Section: Discussionmentioning

confidence: 99%

Patient healthcare trajectory. An essential monitoring tool: a systematic review

Pinaire

Azé

Bringay

et al. 2017

Health Inf Sci Syst

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“…Therefore, survival of pelvic fracture patients depends on hemostasis by TAE and control of coagulopathy by early correction of impaired coagulation factor levels 21, 22, 23. Otherwise, incomplete hemostasis and persistent coagulopathy results in devastating hemorrhage and short‐term mortality, especially in the patients with severe multiple trauma 24.…”

Section: Discussionmentioning

confidence: 99%

Early administration of fibrinogen concentrates improves the short‐term outcomes of severe pelvic fracture patients

Inokuchi

Sawano

Yamamoto

et al. 2017

Acute Medicine & Surgery

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AimHemorrhage from pelvic fracture is a major cause of mortality after blunt trauma. Several studies have suggested that early fibrinogen supplementation improves outcomes of traumatic hemorrhage. Thus, we revised our massive transfusion protocol (MTP) in April 2013 to include early off‐label administration of fibrinogen concentrate. The objective of this study was to evaluate the impact of the revision on the short‐term outcomes of pelvic fracture patients.MethodsThis was a single‐center, retrospective, cohort study. A total of 224 consecutive pelvic fracture patients hospitalized in Saitama Medical Center (Saitama, Japan), 115 before the revision (Group E) and 109 after (Group L), were enrolled. Characteristics of the patients were compared between the groups. Impacts of the revision were evaluated by hazard ratios adjusted for characteristics, injury severity, and coagulation status using Cox's multivariate proportional hazard model. The impact was also evaluated by log–rank test and relative risk of 28‐day mortality between the groups.ResultsThe characteristics were equivalent between the groups. The multivariate analysis revealed that the revision of MTP was significantly related to improved survival with an adjusted hazard ratio (95% confidence interval) of 0.45 (0.07–0.97). The log–rank test gave χ2‐test values of 5.2 (P = 0.022) and 6.7 (P = 0.009), and the relative risks were 0.37 (0.15–0.91) and 0.33 (0.13–0.84), in patients with all Injury Severity Scores and Injury Severity Score ≥21, respectively.ConclusionThe revision of MTP to include aggressive off‐label treatment with fibrinogen concentrate was related to improved short‐term outcomes of severe pelvic fracture patients. However, due to the limitations of the study, the improvement could not be attributed totally to the revision.

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“…5 The strategy of management of unstable patient with fracture pelvis differ from country to another for example in United States with the advance in interventional radiological procedures they prefer to go with interventional radiology but in Europe as most of trauma surgeons are orthopedic surgeons they preferred preperitoneal packing. 6 The major difference between the 2 modalities of management is that with angio embolization you can control arterial bleeding but with pelvic packing the control will be for venous bleeding. With initial management pelvic stabilization is a crucial step which can be done by application of pelvic binder to decrease the volume of pelvic space.…”

Section: Introductionmentioning

confidence: 99%

Management of hemodynamically unstable patients with fracture pelvis Mafraq Hospital experience, UAE

2017

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Background: Multidisciplinary team and multiple approaches were introduced to improve the outcome after significant pelvic trauma. In present study, we are evaluating our institutional management modalities for unstable patients with unstable pelvic fractures using angio-embolization, pelvic packing with or without angio-embolization and conservative management with surgical intensive care unit (SICU) admission.Methods: We reviewed 108 patients admitted with pelvic fractures from January 2013 to September 2014, 19 patients (17.5%) were hemodynamically unstable with pelvic fracture. Massive transfusion protocol was activated in all patients. FAST scan was done. Level 1 trauma CT for the responder and transient responder patients.Results: Out of 19 patients, 7 patients (36.8%) were good responders to resuscitation with maintaining of their hemoglobin stable, with no extravasation of dye, admitted to SICU for conservative management. 4 patients (21%) were responders with CT trauma revealed dye leak so they underwent angio-embolization, SICU admission. 8 patients (42.1%) were non-responders underwent preperitoneal packing, one of them had additional angio-embolization.Conclusions: Preperitoneal packing is an excellent choice for non-responder patients, while angio-embolization can be done for responder and transient responder patients with evident dye extravasation. This study needs more evaluation on a wider clinical scale.

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Evolution of a Multidisciplinary Clinical Pathway for the Management of Unstable Patients With Pelvic Fractures

Cited by 319 publications

References 32 publications

Patient healthcare trajectory. An essential monitoring tool: a systematic review

Patient healthcare trajectory. An essential monitoring tool: a systematic review

Early administration of fibrinogen concentrates improves the short‐term outcomes of severe pelvic fracture patients

Management of hemodynamically unstable patients with fracture pelvis Mafraq Hospital experience, UAE

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