Response of resuscitation in multiple trauma with pelvic fracture.
BACKGROUND
The early management of patients with pelvic injury remains a great challenge for emergency physicians and trauma surgeons. A retrospective study was performed in this hospital to identify the clinical significance of different responses in the resuscitation of pelvic injury.


METHODS
From March 1989 to May 1995, 75 patients with pelvic ring injury who had initially had unstable hemodynamic status were studied. They were divided into four groups as "good response" (GR), "delayed response" (DR), "poor response" (PR) and "no response" (NR) according to the time when hemodynamics became stable after immediate resuscitation.


RESULTS
Motor vehicle accidents (MVA) had a higher incidence than other causes in the trauma mechanism. The fracture types of pelvis had no correlation with the response to resuscitation. The injury severity score (ISS) was higher in the PR group (41.7 +/- 18.3) than in the GR (17.5 +/- 8.6) or DR (19.5 +/- 17.0). The incidence of extrapelvic hemorrhage (EPH) and of mortality rates was higher in the PR group (38% and 75%, respectively), and the DR group (25% and 13%, respectively), than in the GR group (6% and 2%, respectively).


CONCLUSIONS
The responses of resuscitation is a valuable parameter in the management of multiple trauma with pelvic injury. Nonoperative treatment may be tried in patients of good response to resuscitation with EPH. In those patients with poor or delayed response, delayed extrapelvic bleeding (especially from abdominal injury) must be ruled out besides aggressive management for pelvic injury. Poor prognosis can also be expected in those patients with poor response.
Chen
W K
WK
Department of Emergency Medicine, China Medical College Hospital, Taichung, R.O.C.
Shih
H C
HC
Su
C H
CH
Lee
C H
CH
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D050723:Fractures, Bone / Q000401:mortality / Q000628:therapy*; D006470:Hemorrhage / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000293:injuries*; D012151:Resuscitation; D012189:Retrospective Studies