Major Pelvic Ring Injuries: Fewer Transfusions Without Deaths from Bleeding During the Last Decade
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Published on: November 8, 2024
Giles L Devaney1, Seth M Tarrant1,2, Natasha Weaver2
1Department of Traumatology, John Hunter Hospital, Lookout Rd, Newcastle, NSW, 2305, Australia.
Insights
Resuscitation advancements reduced blood transfusion needs for trauma patients with unstable pelvic ring injuries and traumatic shock. Hemorrhage-related mortality was eliminated over a decade.
Area of Science:
- Trauma Surgery
- Resuscitation Medicine
- Emergency Medicine
Background:
- Pelvic fracture-associated bleeding presents significant management challenges and historically high mortality rates.
- The effectiveness of resuscitation advancements in trauma patients with unstable pelvic ring injuries remains under investigation.
- This study investigates the impact of a resuscitation protocol on transfusion requirements in patients with pelvic fractures.
Purpose of the Study:
- To evaluate the association between time elapsed since protocol implementation and decreased blood transfusion requirements.
- To assess the impact of resuscitation advancements on overall and shock-specific transfusion needs.
- To determine the effect on mortality and length of stay.
Main Methods:
- A prospective database of pelvic fracture patients from 2009-2018 at a Level 1 trauma center was reviewed.
- Patients with unstable pelvic ring injuries were included, with analysis stratified for patients in traumatic shock (TS).
- Adjusted regression analysis assessed 24-hour packed red blood cell (PRBC), plasma, cryoprecipitate, platelet, and intravenous fluid (IVF) requirements, alongside length of stay and mortality.
Main Results:
- Overall, 144 patients with unstable pelvic ring injuries received a median of 0 units of PRBC within 24 hours; 47 TS patients received 6 units.
- No significant decrease in 24-hour PRBC requirements was observed for the overall cohort (IRR=0.91, p=0.07).
- TS patients demonstrated significant decreases in 24-hour PRBC (IRR=0.90, p=0.002), plasma (IRR=0.92, p=0.019), cryoprecipitate (IRR=0.88, p=0.001), and IVF (IRR=0.94, p=0.004) requirements.
Conclusions:
- Over the 10-year study period, no deaths were attributed to acute hemorrhage among patients with pelvic fractures.
- Resuscitation advancements were associated with decreased crystalloid and transfusion requirements specifically for patients presenting with traumatic shock.
- The findings suggest protocol improvements positively impact outcomes for high-risk trauma patients.
Background:
Pelvic fracture-associated bleeding can be difficult to control with historically high mortality rates. The impact of resuscitation advancements for trauma patients with unstable pelvic ring injuries is unknown. We hypothesized that the time elapsed since introduction of our protocol would be associated with decreased blood transfusion requirements.
Methods:
A level 1 trauma center's prospective pelvic fracture database was reviewed from 01/01/2009-31/12/2018. All patients with unstable pelvic ring injuries initially presenting to our institution were included. Adjusted regression analysis was performed on the overall cohort and separately for patients in traumatic shock (TS). The primary outcome was 24 h packed red blood cell (PRBC) requirements. Secondary outcomes were 24 h plasma, cryoprecipitate, platelet and intravenous fluid (IVF) requirements, length of stay and mortality.
Results:
Patients with mechanically unstable pelvic ring injuries (n = 144, median [Q1-Q3] age 44 [28-55] years, 74% male) received a median (Q1-Q3) of 0 (0-4) units PRBC within 24 h, with TS patients (n = 47, 42 [28-60] years, 74% male) receiving 6 (4-9) units PRBC. There was no decrease in 24 h PRBC requirements for the overall cohort (years; IRR = 0.91, 95% CI 0.83-1.01; p = 0.07). TS patients had decreases in 24 h PRBC (years; IRR = 0.90, 95%CI 0.84-0.96; p = 0.002), plasma (IRR = 0.92, 95%CI 0.85-0.99; p = 0.019), cryoprecipitate (IRR = 0.88, 95%CI 0.81-0.95; p = 0.001) and IVF (IRR = 0.94, 95%CI 0.90-0.98; p = 0.004). There were 5 deaths (5/144, 3.5%) with no deaths due to acute hemorrhage.
Conclusions:
Over this 10-year period, there was no hemorrhage-related mortality among patients presenting with pelvic fractures. Crystalloid and transfusion requirements decreased for patients presenting with traumatic shock.
