Elsevier

Injury

Volume 45, Issue 4, April 2014, Pages 738-741
Injury

Time to pelvic embolization for hemodynamically unstable pelvic fractures may affect the survival for delays up to 60 min

https://doi.org/10.1016/j.injury.2013.11.007Get rights and content

Abstract

Introduction

We evaluated the relationship between survival and time from arrival to angiography for hemodynamically unstable patients with pelvic trauma.

Methods

A retrospective review of patients admitted to Fukui Prefectural Hospital with pelvic fractures during a 7.5-year period. Charts were reviewed for age, injury characteristics, injury severity score, systolic blood pressure and heart rate on arrival, base deficit, and the lactate concentration on arrival, transfusion requirement, fracture pattern, the time from hospital arrival to angiography, and the time spent in the angiography suite.

Results

Of a total of 140 patients, 68 patients underwent pelvic angiography and embolization. Of the patients, 24 patients were hemodynamically unstable. The average injury severity score was 41.7. Of the patients, 17 had major ligamentous disruption. The average time from hospital arrival to angiography suite was 76 min. Of the hemodynamically unstable 24 patients, there were 12 deaths (50%). Patients who were embolized within 60 min of arrival had a significantly lower mortality rate (16 vs. 64%; p = 0.04). There was no embolization-related complication and repeat angiography was not required in all patients.

Conclusion

Earlier pelvic embolization within 60 min may affect the survival of hemodynamically unstable patients with pelvic fracture.

Introduction

The management of hemodynamically unstable patients with pelvic fracture is a multidisciplinary challenge with high mortality and remains a controversial issue [1], [2], [3], [4]. Haemorrhage due to disruption of the surrounding venous and arterial vessels is the leading cause of death in these patients and require prompt therapy aimed at hemostasis [1], [2].

The combination of angiography and embolization of bleeding arterial vessels has emerged as an excellent management method [5]. Some have used angiography without invasive external fixation if haemodynamic instability persisted despite volume resuscitation for 24 h [5], [6], [7]. Angiography within 90 min with external fixation was reported [8]. It is unclear whether the delay in controlling bleeding from pelvic trauma is associated with worsened outcomes. We hypothesized that earlier pelvic embolization would reduce the mortality of hemodynamically unstable patients with pelvic fractures. This retrospective study analyzed our protocol consisting of early embolization in hemodynamically unstable patients with pelvic fracture, and evaluated the relationship between survival and time from arrival to angiography.

Section snippets

Methods

We conducted a review of a consecutive series of 140 trauma patients with pelvic ring fractures who were admitted to Fukui Prefectural Hospital (FPH) from April 1, 2005, through September 30, 2012. The patients were transported to the hospital by ground transportation or by helicopter. The patient data were obtained from the hospital records. Patients with any pelvic fractures were included in this study. Patients who died in the emergency department and patients requiring emergency laparotomy

Results

During the 7.5-year period, 140 patients with pelvic fractures were treated in the FPH. 68 patients (49%) underwent pelvic angiography and embolization (Fig. 2). Of the patients, 24 patients (35%) were hemodynamically unstable. All 44 hemodynamically stable patients had extravasations on CT. The mean patient age was 6 ± 22 years and sex distribution was 13 male and 11 female. The average injury severity score (ISS) was 41.7 ± 9.1. Out of the patients, 17 (70%) had major ligamentous disruption. All

Discussion

Early identification and control of pelvic haemorrhage is pivotal to decreasing pelvic fracture-related mortality [5], [7], [10]. This haemorrhage can originate from injury to arteries, injury to the venous plexus in the pelvis, and fracture bleeding. The most common methods for arresting pelvic bleeding are external fixation of the pelvic fracture, and angiography for the identification and embolization of arterial pelvic bleeding.

Angiographic embolization is considered by most authors to be

Conflict of interest statement

There are no potential conflicts of interest. The authors report this study did not receive any outside funding.

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