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Improvement in institutional protocols leads to decreased mortality in patients with haemodynamically unstable pelvic fractures
  1. Mina Cheng1,
  2. Moon-Tong Cheung1,
  3. Kin-Yan Lee1,
  4. Kin-Bong Lee2,
  5. Susan-C H Chan3,
  6. Amy-C Y Wu4,
  7. Yu-Fat Chow4,
  8. Annice-M L Chang5,
  9. Hiu-Fai Ho5,
  10. Kelvin-K W Yau6
  1. 1Department of Surgery, Queen Elizabeth Hospital, Hong Kong
  2. 2Department of Orthopaedics & Traumatology, Queen Elizabeth Hospital, Hong Kong
  3. 3Department of Radiology & Imaging, Queen Elizabeth Hospital, Hong Kong
  4. 4Department of Anaesthesiology & Operating Theatre Services, Queen Elizabeth Hospital, Hong Kong
  5. 5Department of Accident & Emergency, Queen Elizabeth Hospital, Hong Kong
  6. 6Department of Management Sciences, City University of Hong Kong, Hong Kong
  1. Correspondence to Dr Moon-Tong Cheung, Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong; cheungmt1{at}ha.org.hk, cheung_mt{at}hotmail.com

Abstract

Background The mortality rate in patients with haemodynamically unstable pelvic fractures is as high as 40–60%. In recent years, angioembolisation and pelvic packing have been introduced as part of a multimodality treatment for these patients. Protocol-driven management has been shown to improve outcomes.

Patients and methods This is a Level III retrospective cohort study of patients suffering from unstable pelvic fractures from 1 January 1996 to 30 September 2011. The aim of the study was to review our results, particularly in terms of mortality through the evolution of three phases of treatment protocols: preangiography, angiography and pelvic packing.

Results The overall 30-day mortality rate for all patients was 47.2%, with a rate of 63.5% in the preangiography phase, 42.1% in the angiography phase and 30.6% in the pelvic packing phase. Multivariate logistic regression analysis identified the use of retroperitoneal packing as a significant independent predictive factor for 24 h mortality.

Conclusions Our results showed an improvement in patient survival with sequential protocols over the study period, during which we incorporated a multidisciplinary approach to managing these complicated pelvic fractures. The results strongly suggest that retroperitoneal packing should be highly recommended for bleeding subsequent to pelvic fracture, in addition to other modalities of treatment.

  • Trauma, Spine and Pelvis

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