Protocol-driven approach for managing bleeding in abdominal and pelvic trauma
Author Information
Author(s): Chiara Osvaldo, Cimbanassi Stefania, Castelli Fabio, Spagnolo Rosario, Girotti Paolo, Pizzilli Giacinto, Pitidis Alessio, Andreani Sara, Pugliese Raffaele, Capitani Dario
Primary Institution: Dipartimento di Emergenza Accettazione – Trauma Team Ospedale Niguarda Ca'Granda Milano, Universita' degli Studi di Milano, Italy
Hypothesis
In multi-trauma bleeding patients with pelvic fractures causing mechanical instability, a main source of hemorrhage is usually the pelvic fracture itself, while in patients with mechanically stable pelvic fractures, the priority is to search and treat extrapelvic sources of hemorrhage.
Conclusion
The study found that a protocol-driven approach significantly improved the management of bleeding in patients with abdominal and pelvic trauma.
Supporting Evidence
- 87 patients with abdominal-pelvic trauma were reviewed over a 16-month period.
- Significant pelvic hemorrhage was observed in 87% of unstable pelvic fractures.
- Emergency celiotomy was therapeutic in all patients with positive ultrasound findings.
- Overall mortality of the study population was 29%, with higher mortality in the unstable pelvic fracture group.
Takeaway
This study shows that doctors can better help patients with serious injuries by following a specific plan to find and stop bleeding from pelvic fractures.
Methodology
Patients with abdominal-pelvic trauma and unstable hemodynamics were managed using a protocol based on pelvic fracture patterns and emergency ultrasound.
Potential Biases
Potential bias due to the single-center design and the specific patient population.
Limitations
The study was limited to a specific hospital and may not be generalizable to all trauma centers.
Participant Demographics
Patients included were major trauma cases with abdominal-pelvic injuries, primarily adults.
Statistical Information
P-Value
<0.01
Statistical Significance
p<0.01
Digital Object Identifier (DOI)
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