Staged management and outcome of combined pelvic and liver trauma. An international experience of the deadly duo.
Pelvic fracture associated with liver trauma is not an uncommon injury combination in multiple trauma and is associated with high morbidity and mortality. The aim of this study was to examine the characteristics of this specific patient group, to describe the diagnostic and treatment protocols and finally to analyse risk factors associated with mortality. Data were collected over a 6-year period, ending in 2001. The pelvic injury was graded according to the Tile classification system and the hepatic injury was scored using the organ injury scale (OIS). Treatment protocol, associated injuries, complications, length of ICU/Hospital stay and mortality were recorded and analysed. A total of 140 patients (40% female) with a mean age of 35.1+/-15.9 years and a median ISS of 41 were included in this study. The overall mortality rate was 40.7%. Binomial logistic regression analysis revealed age, initial blood pressure, transfusion requirement as well as the severity of head, chest, spleen and liver injury as independent parameters predicting reduced survival rates. This deadly duo of injuries presents a challenge to the trauma surgeon. Rapid assessment and treatment is required to prevent death by haemorrhage. The presence of concomitant injuries renders the patient very sensitive to ongoing or additional physiological disturbance. The principles of 'damage control surgery' must be applied to avoid complications such as acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS).
Grotz
Martin Rolf Wolfgang
MR
Department of Trauma and Orthopaedic Surgery, St. James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
Gummerson
Nigel William
NW
Gänsslen
Axel
A
Petrowsky
Henrik
H
Keel
Marius
M
Allami
Mohamad Kasim
MK
Tzioupis
Christopher
C
Trentz
Otmar
O
Krettek
Christian
C
Pape
Hans-Christoph
HC
Giannoudis
Peter V
PV
D000293:Adolescent; D000328:Adult; D000368:Aged; D004812:Epidemiologic Methods; D005260:Female; D005592:Fracture Fixation / Q000379:methods; D050723:Fractures, Bone / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008099:Liver / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D010384:Pelvic Bones / Q000293:injuries*; D011014:Pneumonia / Q000209:etiology; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000209:etiology; D016896:Treatment Outcome