Predicting the need to pack early for severe intra-abdominal hemorrhage.
OBJECTIVE
To determine if the decision to pack for hemorrhage could be refined.


METHODS
Seventy consecutive trauma patients for whom packing was used to control hemorrhage were studied. The patients had liver injuries, abdominal vascular injuries, and bleeding retroperitoneal hematomas. Preoperative variables were analyzed and survivors compared with nonsurvivors.


RESULTS
Packing controlled hemorrhage in 37 (53%) patients. Significant differences (p < 0.05) between survivors and nonsurvivors were Injury Severity Score (29 vs. 38), initial pH (7.3 vs. 7.1), platelet count (229,000 vs. 179,000/mm3), prothrombin time (14 vs. 22 seconds), partial thromboplastin time (42 vs. 69 seconds), and duration of hypotension (50 vs. 90 minutes). Nonsurvivors received 20 units of packed red blood cells before packing compared to 13 units for survivors.


CONCLUSIONS
Patients who suffer severe injury, hypothermia, refractory hypotension, coagulopathy, and acidosis need early packing if they are to survive. Failure to control hemorrhage is related to severity of injury and delay in the use of pack tamponade. A specific protocol that mandates packing when parameters reach a critical limit should be considered.
Garrison
J R
JR
Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA.
Richardson
J D
JD
Hilakos
A S
AS
Spain
D A
DA
Wilson
M A
MA
Miller
F B
FB
Fulton
R L
RL
D000007:Abdominal Injuries / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D001458:Bandages; D005260:Female; D006470:Hemorrhage / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016019:Survival Analysis; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*