Mortality in retroperitoneal hematoma

Eighty-one patients sustained retroperitoneal hematoma (RH) from blunt (70%) and penetrating (30%) trauma. Retroperitoneal hematomas were classified into 10 centro-medial Zone I, 25 lateral Zone II, and 46 pelvic Zone III hematomas. The mean injury Severity Score (ISS) for the entire series was 26.4 +/- 14. The mean ISS of nonsurvivors was 37.6 +/- 12. Overall mortality was 20%; if head injury deaths are excluded (six), mortality was 13%. Retroperitoneal hematoma associated with pelvic fracture had a mortality of 19%. Incidence of respiratory failure for entire series, excluding head trauma, was 29%. Respiratory failure occurred in 37% of patients with Zone III injuries. A requirement for ventilatory support greater than 48 hours was associated with a mortality of 35%. PaO2/FIO2 at 48 hours in intubated patients was significantly decreased in nonsurvivors compared to survivors, whereas the mean ISS of this subset of patients did not differentiate between survivors and nonsurvivors.