Pelvic Trauma

Stahel, Philip F.; Stahel, Vincent P.

doi:10.1007/978-3-031-22599-4_102

Cited by 2 publications

(1 citation statement)

References 34 publications

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“…The outcomes from our study and logic suggest that this might be appropriate for traumatic injuries to the abdomen, pelvis, or retroperitoneum in patients who are not physiologically compromised. 15,43,44 There is some evidence of successful implementation of this strategy; however, additional studies evaluating both surgical scope requirements and health system level implementation practices would further identify potential benefits and challenges for this approach to trauma care during mass casualty incidents. 19 More recently, the US Military has directed its attention from combating insurgencies toward clinical readiness for large-scale combat operations.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of urological and gynecological surgeons as force multipliers for mass casualty trauma care

Andreatta,

Graybill,

Bradley

et al. 2024

J Trauma Acute Care Surg

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BACKGROUND The clinical demands of mass casualty events strain even the most well-equipped trauma centers and are especially challenging in resource-limited rural, remote, or austere environments. Gynecologists and urologists care for patients with pelvic and abdominal injuries, but the extent to which they are able to serve as “force multipliers” for trauma care is unclear. This study examined the abilities of urologists and gynecologists to perform 32 trauma procedures after mentored training by expert trauma educators to inform the potential for these specialists to independently care for trauma patients. METHODS Urological (6), gynecological surgeons (6), senior (PGY5) general surgery residents (6), and non-trauma trained general surgeons (8) completed a rigorous trauma training program (ASSET+). All participants were assessed in their trauma knowledge and surgical abilities performing 32 trauma procedures pre/post mentored training by expert trauma surgeons. Performance benchmarks were set for knowledge (80%) and independent, accurate completion of all procedural components within a realistic time window (90%). RESULTS General surgery participants demonstrated greater trauma knowledge than gynecologists and urologists; however, none of the specialties reached the 80% benchmark. Pre-training, general surgery and urology participants outperformed gynecologists for overall procedural abilities. Post-training, only general surgeons met the 90% benchmark. Post-hoc analysis revealed no differences between the groups performing most pelvic and abdominal procedures, however knowledge associated with decision making and judgment in the provision of trauma care was significantly below the benchmark for gynecologists and urologists, even after training. CONCLUSION For physiologically stable patients with traumatic injuries to the abdomen, pelvis or retroperitoneum, these specialists might be able to provide appropriate care; however, they would best benefit trauma patients in the capacity of highly skilled assisting surgeons to trauma specialists. These specialists should not be considered for solo resuscitative surgical care. LEVEL OF EVIDENCE Therapeutic/Care Management, Level III/IV.

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Section: Discussionmentioning

confidence: 99%

Evaluation of urological and gynecological surgeons as force multipliers for mass casualty trauma care

Andreatta,

Graybill,

Bradley

et al. 2024

J Trauma Acute Care Surg

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The pathophysiology of pelvic ring injuries: a review

Stahel,

Ziran

2024

Patient Saf Surg

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Traumatic pelvic ring injuries continue to represent a major challenge due to the high rates of post-injury mortality of around 30-40% in the peer-reviewed literature. The main root cause of potentially preventable mortality relates to the delayed recognition of the extent of retroperitoneal hemorrhage and post-injury coagulopathy. The understanding of the underlying pathophysiology of pelvic trauma is predicated by classification systems for grading of injury mechanism and risk stratification for developing post-injury coagulopathy with subsequent uncontrolled exsanguinating hemorrhage. This review article elaborates on the current understanding of the pathophysiology of severe pelvic trauma with a focus on the underlying mechanisms of retroperitoneal bleeding and associated adverse outcomes.

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Pelvic Trauma

Cited by 2 publications

References 34 publications

Evaluation of urological and gynecological surgeons as force multipliers for mass casualty trauma care

Evaluation of urological and gynecological surgeons as force multipliers for mass casualty trauma care

The pathophysiology of pelvic ring injuries: a review

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