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Management guidelines for hypotensive pelvic fracture patients
C F Allen1, P W Goslar, M Barry
1Trauma Service, Good Samaritan Regional Medical Center, Phoenix, Arizona 85006, USA.
The American Surgeon
|August 31, 2000
Summary
Managing complex pelvic fractures in trauma patients requires careful monitoring. Key indicators for mortality include low blood pressure and base excess, guiding resuscitation and management strategies.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Emergency Medicine
Background:
- Pelvic fractures are common in blunt trauma, often with associated injuries.
- Mortality is frequently linked to other system injuries or hemorrhage.
- Existing studies focus on fracture classification rather than management of critically ill patients.
Purpose of the Study:
- To analyze management factors predicting mortality in hypotensive pelvic fracture patients.
- To identify critical indicators for improving outcomes in complex pelvic fracture cases.
- To evaluate the effectiveness of a specific trauma surgeon protocol.
Main Methods:
- Retrospective analysis of 692 pelvic fracture cases.
- Focus on 75 hypotensive patients (systolic BP < 90) with complex fractures.
- Utilized blood pressure, base excess, and Injury Severity Score (ISS) as key metrics.
Main Results:
- Low base excess (BE < or = -5) significantly correlated with higher mortality (P<0.05).
- Persistent low blood pressure (BP < or = 90) upon leaving the trauma room indicated increased mortality (P<0.01).
- Injury Severity Score effectively predicted mortality; early operative intervention within 24 hours was not detrimental.
Conclusions:
- Resuscitation guided by base excess and maintaining blood volume are crucial.
- Blood pressure, base excess, and ISS are vital for evaluating management of severely injured patients.
- Overall mortality in this cohort was 14.7%, with emergent angiography showing success in some cases.