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Source of bleeding in trauma patients with pelvic fracture and haemodynamic instability
Sandra Montmany1, Pere Rebasa1, Alexis Luna1
1Departamento de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Taulí, Sabadell, España.
Insights
Pelvic fractures in trauma patients often cause fatal hypovolemic shock. Understanding the bleeding source, linked to fall or impact mechanisms and fracture type, is crucial for effective trauma care.
Area of Science:
- Trauma surgery
- Emergency medicine
- Orthopedic trauma
Background:
- Hypovolemic shock is a primary cause of mortality in trauma patients with pelvic fractures.
- Identifying the source of bleeding is critical for managing these high-risk injuries.
Purpose of the Study:
- To analyze the association between the source of bleeding, mechanism of action (fall vs. impact), and type of pelvic fracture (stable vs. unstable).
Main Methods:
- Prospective descriptive study of hemodynamically unstable trauma patients (SBP <90 and/or HR > 100) with pelvic fractures (Tile classification).
- Included 63 patients from 1088 trauma cases.
Main Results:
- Patients experiencing falls from great heights had higher rates of bleeding from the fracture itself (85%) compared to impact victims (44%).
- Unstable fractures were more likely to bleed from the fracture site (70%), while stable fractures often involved bleeding from associated injuries (65%).
- Pelvic bleeding risk exceeded 80% in fall victims, irrespective of fracture type.
Conclusions:
- Mechanism of action is a key determinant of bleeding source in pelvic fractures.
- Fall victims predominantly bleed from the fracture, whereas impact victims may bleed from the fracture or associated injuries, influenced by fracture stability.
Introduction:
The main cause of mortality in trauma patients with pelvic fractures is hypovolemic shock. We analyzed the association between the source of bleeding, mechanism of action and type of fracture.
Methods:
Prospective descriptive study involving trauma patients older than 16 years old, admitted to the intensive care unit or dead before admission, with pelvic fractures and hemodynamic instability. Hemodynamic instability was defined as SBP <90 and/or HR> 100 beats/min. Pelvic fracture was defined by the Tile classification.
Results:
A total of 157 of 1088 trauma patients had pelvic fracture. We included 63 patients, all hemodynamically unstable. A total of 85% of pelvic fractures after falls from great heights bled from the fracture itself, compared to only 44% of victims of impact (hit). A total of 65% of patients with stable pelvic fracture bled from associated lesions; 70% of patients with unstable fracture bled from the fracture itself. There is an interaction between the mechanism of action and type of fracture. The probability of pelvic bleeding is higher in the precipitated patient (> 80%) regardless of the type of fracture. Bleeding from associated injuries is greater in impact victims, doubling when the fracture is stable (91%).
Conclusions:
Mechanism of action is a key to determine the source of bleeding in patients with pelvic fracture. After falls patients bleed from the fracture itself, while patients with an impact (hit) can bleed both from the fracture and associated injuries, depending on the type of fracture.
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