Adherence to protocol in pregnant trauma patients? A 12-year retrospective study

We investigated whether the standard (ATLS) trauma protocol was adhered to in cases of suspected multi-traumatized pregnant patients and if serious injuries were overlooked. We hypothesized that radiographic studies would be less frequent in pregnant trauma patients.

Forty-eight pregnant trauma patients were received in the observational period from January 2000 until May 2012; median age 30 years (range 16-40) and median stage of pregnancy 22 weeks (range 4-40). A retrospective review of patient files was performed.

Twenty-one percent of the pregnant trauma patients received a full trauma CT (T-CT) scan (head to pelvis), which was significantly lower than the percentage (62 %) of all primarily referred trauma patients in the same period. In the last four years of observation, the use of radiographic studies among pregnant trauma patients increased considerably. Along with this increase in the tendency to use T-CT over time during the observational period, there was also a rise in the median ISS. In addition, radiographic studies of the pelvis and abdominal area were performed only half as frequently as studies of the neck and chest.

Adherence to the ATLS protocol in pregnant trauma patients was low in relation to radiographic studies but, in spite of this, no known significant injuries were missed. We found that a pelvic fracture seems to be predictive of a high risk of obstetric complications, such as intrauterine death or the need for cesarean section, but we were not able to relate trauma in general to a higher risk of cesarean section or premature birth.