Management guidelines for hypotensive pelvic fracture patients

Pelvic fractures are common in blunt trauma patients and are often associated with other system injuries. Most studies describe the type of pelvic fractures and classify them by the forces creating the injury. Mortality from these fractures is due most often to other system injuries or to hemorrhage. Mortality ranges from 5 to 20 per cent depending on complexity and number of systems injured. We studied 692 cases of pelvic fractures and analyzed the seriously ill patients. They were identified by blood pressure (BP) less than 90 systolic on presentation to the trauma room and having a complex pelvic fracture. The management of these patients was by a protocol used by a group of eight trauma surgeons. This group of 75 hypotensive pelvic fracture patients were analyzed to identify significant factors in their management that predicted mortality. Patients with base excess (BE) values < or =-5 were significantly more likely to die (P<0.05). Patients with BP < or =90 on leaving the trauma room had a significantly higher mortality (P<0.01). Injury Severity Score predicted mortality and can be useful as a tool for quality assurance and process improvement. The early operative intervention to fix associated fractures within 24 hours was not detrimental to patient outcome. Overall mortality in this very sick population was 14.7 per cent. Emergent angiography was used successfully on 14 patients. Seven patients died of continued bleeding. The most important management guidelines for these seriously injured, complex patients are: 1) resuscitate with BE used as a monitor; 2) keep patient blood volume as close to normal as possible; 3) use BP, BE, and ISS to evaluate management of these patients.