Three-in-one protocol reduces mortality of patients with haemodynamically unstable pelvic fractures—a five year multi-centred review in Hong Kong

Cheng, Mark Ming‐Cheng; Lee, Kin-Yan; Chang, Annice; Ho, Hiu Fai; Chan, Lily-P S; Lee, Kin-Bong; Kwok, Philip-C H; Lee, Alexander-C W; Wong, Kevin-Y K; Kam, Chak‐Wah; Leung, Gilberto-K K; Wong, John-K S; Cheung, Nicole W. T.; Yeung, Janice-H H; Choi, Shing-Hing; Lau, Tak-Wing; Wong, Heidi-H T; Leung, Ming

doi:10.1007/s00264-018-3842-x

Cited by 15 publications

(27 citation statements)

References 13 publications

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“…Hemodynamically unstable patients due to pelvic fracture-related bleeding have a mortality rate up to 60%, and therefore need an emergent multidisciplinary approach involving external fixation of the pelvis, and retroperitoneal pelvic packing complemented by angio-embolization where needed [8]. Such an approach not only lowers mortality but also morbidity and usage of blood products [9]. In more stable patients with such injuries who undergo surgery in a more controlled environment, CS of blood loss intra-operatively is an option.…”

Section: Discussionmentioning

confidence: 99%

Intra-operative cell salvage in pelvic and acetabular fracture surgery: a retrospective comparative study

Jawed

Ahmed

Williams

2018

International Orthopaedics (SICOT)

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Section: Discussionmentioning

confidence: 99%

Intra-operative cell salvage in pelvic and acetabular fracture surgery: a retrospective comparative study

Jawed

Ahmed

Williams

2018

International Orthopaedics (SICOT)

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“…In a recent multicenter analysis, this protocol was identified as the single most independent predictive factor for 30-day, 7-day, and 24-h mortality rates. 71 Implementation of such a protocol reduces unnecessary time spent on discussion, arrangement for the three crucial procedures, and transfers of these highly unstable patients. The three different measures adopted in this sequential protocol are supplementary and complement each other in achieving hemostasis in unstable pelvic fractures.…”

Section: Three In One Protocolmentioning

confidence: 99%

Management of pelvic injuries in hemodynamically unstable polytrauma patients – Challenges and current updates

Perumal

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Pelvic injuries are notorious for causing rapid exsanguination, and also due to concomitant injuries and complications, they have a relatively higher mortality rate. Management of pelvic fractures in hemodynamically unstable patients is a challenging task and has been variably approached. Over the years, various concepts have evolved, and different guidelines and protocols were established in regional trauma care centers based mainly on their previous experience, outcomes, and availability of resources. More recently, damage control resuscitation, pelvic angioembolization, and acute definitive internal fixation are being employed in the management of these unstable injuries, without clear consensus or guidelines. In this background, we have performed a computerized search using the Cochrane Database of Systematic Reviews, Scopus, Embase, Web of Science, and PubMed databases on studies published over the past 30 years. This comprehensive review aims to consolidate available literature on the current epidemiology, diagnostics, resuscitation, and management options of pelvic fractures in polytraumatized patients with hemodynamic instability with particular focus on damage control resuscitation, pelvic angioembolization, and acute definitive internal fixation.

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“…For example, concurrent preperitoneal packing, external fixation and pelvic arteries embolisation (3-in-1 pelvic damage control procedure) have been shown to improve survival. 8,9 This study was conducted to determine useful early predictive factors to identify patients with more severe injury and higher mortality. This group of patients could benefit from immediate aggressive early intervention.…”

Section: Key Resultsmentioning

confidence: 99%

Epidemiological study of major pelvic fracture in Hong Kong and analysis of predictors for mortality

Kwong

Yang

Wong

et al. 2019

Hong Kong Journal of Emergency Medicine

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Objectives and Background Pelvic fracture causes significant mortality and morbidities. The purpose of this study is to identify the characteristics of patients with pelvic fracture in Hong Kong and to determine the factors predicting mortality. The result could help to identify high-risk patients who might benefit from more intensive evaluation and intervention. Method: Five hundred and eight patients (age > 12 years old) with pelvic fractures were identified from the trauma registries of four designated trauma centres in Hong Kong from 1 January 2005 to 31 December 2012. Patient baseline characteristics and outcomes were analysed. Stepwise logistic regression was performed to identify independent clinical predictors for mortality. Result: Mean age was 45.4 ± 19.2 years, 43.3% were female, mean length of hospital stay was 27.9 ± 42.4 days and mean length of intensive care unit stay was 4.8 ± 6.8 days. Injury severity score was 28.9 ± 18.7, revised trauma score was 7.2 ± 2 and 30-day mortality was 20.9%. Stepwise logistic regression identified patient’s age, presenting systolic blood pressure, initial Glasgow Coma Scale, injuries to the thoracic and abdominal regions, first base excess and the volume of red blood cell transfusion required within the first 6 h to be independent risk factors predicting mortality. Conclusion: Pelvic fracture is associated with significant risk of mortality in major trauma patients. Clinical characteristics obtained during emergency department resuscitation can help in selecting patients for timely aggressive interventions.

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Three-in-one protocol reduces mortality of patients with haemodynamically unstable pelvic fractures—a five year multi-centred review in Hong Kong

Abstract: Implementation of the multidisciplinary three-in-one pelvic damage control protocol reduces mortality and therefore should be highly recommended. The results are convincing as it has eliminated the limitations of our previous single-centred trial.

Cited by 15 publications

References 13 publications

Intra-operative cell salvage in pelvic and acetabular fracture surgery: a retrospective comparative study

Intra-operative cell salvage in pelvic and acetabular fracture surgery: a retrospective comparative study

Management of pelvic injuries in hemodynamically unstable polytrauma patients – Challenges and current updates

Epidemiological study of major pelvic fracture in Hong Kong and analysis of predictors for mortality

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