Osborn, Injury 2009 - Direct Retroperitoneal Pelvic Packing versus Pelvic Angiography: A Comparison of Two Management Protocols for Haemodynamically Unstable Pelvic Fractures

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Direct Retroperitoneal Pelvic Packing versus Pelvic Angiography: A Comparison of Two Management Protocols for Haemodynamically Unstable Pelvic Fractures

Osborn, Stahel, et al.·Injury·2009·255 citations·Retrospective cohort

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Purpose

To evaluate the outcomes of haemodynamically unstable cases of pelvic ring injury treated with a protocol focused on either direct retroperitoneal pelvic packing or early pelvic angiography and embolisation.

Methods

A retrospective review of a prospectively collected database in an academic level I trauma centre, treating matched haemodynamically unstable cases of pelvic fracture with either pelvic packing (PACK group, n=20) or early pelvic angiography (ANGIO group, n=20). Physiological markers of haemorrhage, time to intervention, transfusion requirements, complications and early mortality were recorded.

Results

The PACK group underwent operative packing at a median of 45min from admission; the median time to angiography in the ANGIO group was 130min.
The PACK group, but not the ANGIO group, demonstrated a significant decrease in blood transfusions over the next 24h post intervention.
In the ANGIO group, 10 people required embolisation and 6 died, 2 from acute haemorrhage; in the PACK group, 3 people required embolisation; 4 died, none due to uncontrolled haemorrhage.

Conclusions

Pelvic packing is as effective as pelvic angiography for stabilising haemodynamically unstable casualties with pelvic fractures, decreases need for pelvic embolisation and post-procedure blood transfusions, and may reduce early mortality due to exsanguination from pelvic haemorrhage.

Copyright remains with the authors and publisher.

Direct Retroperitoneal Pelvic Packing versus Pelvic Angiography: A Comparison of Two Management Protocols for Haemodynamically Unstable Pelvic Fractures

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Direct Retroperitoneal Pelvic Packing versus Pelvic Angiography: A Comparison of Two Management Protocols for Haemodynamically Unstable Pelvic Fractures

Osborn, Stahel, et al.·Injury·2009·255 citations·Retrospective cohort

|

Purpose

To evaluate the outcomes of haemodynamically unstable cases of pelvic ring injury treated with a protocol focused on either direct retroperitoneal pelvic packing or early pelvic angiography and embolisation.

Methods

A retrospective review of a prospectively collected database in an academic level I trauma centre, treating matched haemodynamically unstable cases of pelvic fracture with either pelvic packing (PACK group, n=20) or early pelvic angiography (ANGIO group, n=20). Physiological markers of haemorrhage, time to intervention, transfusion requirements, complications and early mortality were recorded.

Results

The PACK group underwent operative packing at a median of 45min from admission; the median time to angiography in the ANGIO group was 130min.
The PACK group, but not the ANGIO group, demonstrated a significant decrease in blood transfusions over the next 24h post intervention.
In the ANGIO group, 10 people required embolisation and 6 died, 2 from acute haemorrhage; in the PACK group, 3 people required embolisation; 4 died, none due to uncontrolled haemorrhage.

Conclusions

Pelvic packing is as effective as pelvic angiography for stabilising haemodynamically unstable casualties with pelvic fractures, decreases need for pelvic embolisation and post-procedure blood transfusions, and may reduce early mortality due to exsanguination from pelvic haemorrhage.

Copyright remains with the authors and publisher.

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