Acute Management of Hemodynamically

Unstable Pelvic Trauma Patients: Time for a

Change? Multicenter Review of Recent
Practice
Diederik Verbeek Michael Sugrue Zsolt Balogh Danny Cass
Ian Civil Ian Harris Thomas Kossmann Steve Leibman Valerie Malka
Anthony Pohl Sudhakar Rao Martin Richardson Michael Schuetz
Caesar Ursic Vanessa Wills
Published online: 3 May 2008
Societe Internationale de Chirurgie 2008

Introduction
The early management of hemodynamically unstable
patients with a pelvic fracture following blunt trauma
poses a significant challenge owing to competing clinical
priorities and a reported mortality of 10% to 42%.
Uncontrolled pelvic bleeding is a contributing factor to
mortality in 42% of these cases.
To improve the survival of these patients, the source of
hemorrhage needs to be identified during the early phase
of resuscitation to enable rapid control of bleeding

Materials and methods

Amulticenter retrospective study was undertaken to evaluate trends in the
management of patients with hemodynamically unstable pelvic fractures.
Patients were identified from the individual hospital trauma registries. All
major blunt trauma patients [Injury Severity Score (ISS) C 16] with a major
pelvic fracture [Abbreviated Injury Score (AIS), pelvis C 3] and hemodynamic
instability were included in the study [19 ].
Hemodynamic instability was defined as having a systolic blood pressure
(SBP) of B 90 mmHg on admission or receiving at least 6 units of blood
within the first 24 hours following admission.
Exclusion criteria included age 18 years, the presence of penetrating
injuries or isolated acetabular or pubic ramus fractures, interhospital
transfers, those deemed dead on arrival, and uncontrollable thoracic
hemorrhage.

Results
Between January 2000 and December 2003, a total of
11,109 major blunt trauma patients were admitted to
11 trauma centers (mortality 1632/11,109, or 14.7%).
Major pelvic fractures occurred in 1050 patients with an
associated mortality of 17.0% (179/1050). Of these
1050, 217 patients (20.7%) were hemodynamically
unstable and thus eligible for enrollment in this study.

 The introduction of a clinical pathway with a more

prominent position for pelvic angiography/embolization
to control arterial bleeding led to a significant decrease
in mortality in a retrospective study of 216 patients with
hemodynamically unstable pelvic fractures

Conclusion
The HRM of major pelvic trauma in this study is unacceptably
high, especially in the primary laparotomy group.
Although all trauma centers have intervention radiology
available, the considerable variation in the management of this
high risk cohort may be due to differences in institutions
systems to provide timely angioembolization and access to
orthopedic surgery
After excluding all other potential sources of bleeding, the
abdomen should be promptly assessed (FAST, DPA/DPL). A
positive abdominal assessment warrants laparotomy. The pelvis
should be rapidly stabilized using a bed sheet or pelvic binder.