Increasing the Threshold to Perform Preperitoneal Pelvic Packing Decreases Morbidity Without Affecting Mortality

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Surgical Protocols

Background:

• Pelvic ring injuries often lead to significant hemorrhage and hemodynamic instability (HDI).
• Preperitoneal pelvic packing (PPP) is a critical intervention for controlling pelvic bleeding.
• Optimizing transfusion thresholds for PPP is essential for patient management.

Purpose of the Study:

• To evaluate the effectiveness of an updated protocol that raised the red blood cell (RBC) transfusion threshold for performing PPP.
• To assess the impact of this change on mortality from hemorrhage, pelvic infections, and venous thromboembolisms (VTEs).

Main Methods:

• Retrospective review of severely injured patients with pelvic ring injuries at an urban level 1 trauma center.
• Comparison of outcomes between a historical protocol (threshold of 2 RBC units) and an updated protocol (threshold of 4 RBC units).
• Analysis included mortality, anterior pelvic space infections, and VTEs in patients with HDI (systolic blood pressure <90 mm Hg).

Main Results:

• The updated protocol significantly decreased the incidence of PPP (8.3% vs. 65.1%).
• Patients under the updated protocol experienced fewer anterior pelvic infections (0.0% vs. 13.9%) and VTEs (8.3% vs. 30.2%).
• There was no significant difference in deaths from acute hemorrhagic shock between the two protocols (5.6% vs. 7.0%).

Conclusions:

• Increasing the RBC transfusion threshold for PPP in severely injured patients with pelvic ring injuries is safe and effective.
• This protocol modification reduces infectious complications and VTEs.
• The updated protocol does not compromise the management of acute hemorrhage.