title: Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture--update and systematic review.
abstract: BACKGROUND
  Hemorrhage from pelvic fracture is common in victims of blunt traumatic injury. In 2001, the Eastern Association for the Surgery of Trauma (EAST) published practice management guidelines for the management of hemorrhage in pelvic trauma. Since that time there have been new practice patterns and larger experiences with older techniques. The Practice Guidelines Committee of EAST decided to replace the 2001 guidelines with an updated guideline and systematic review reflecting current practice.
  
  
  METHODS
  Building on the previous systematic literature review in the 2001 EAST guidelines, a systematic literature review was performed to include references from 1999 to 2010. Prospective and retrospective studies were included. Reviews and case reports were excluded. Of the 1,432 articles identified, 50 were selected as meeting criteria. Nine Trauma Surgeons, an Interventional Radiologist, and an Orthopedic Surgeon reviewed the articles. The EAST primer was used to grade the evidence.
  
  
  RESULTS
  Six questions regarding hemorrhage from pelvic fracture were addressed: (1) Which patients with hemodynamically unstable pelvic fractures warrant early external mechanical stabilization? (2) Which patients require emergent angiography? (3) What is the best test to exclude extrapelvic bleeding? (4) Are there radiologic findings which predict hemorrhage? (5) What is the role of noninvasive temporary external fixation devices? and (6) Which patients warrant preperitoneal packing?
  
  
  CONCLUSIONS
  Hemorrhage due to pelvic fracture remains a major cause of morbidity and mortality in the trauma patient. Strong recommendations were made regarding questions 1 to 4. Further study is needed to answer questions 5 and 6.
authors.affiliation: Departments of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA. cullinane.daniel@mayo.edu
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Cullinane
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Schiller
authors.forename: Martin D
authors.initials: MD
authors.lastname: Zielinski
authors.forename: Jaroslaw W
authors.initials: JW
authors.lastname: Bilaniuk
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Collier
authors.forename: John
authors.initials: J
authors.lastname: Como
authors.forename: Michelle
authors.initials: M
authors.lastname: Holevar
authors.forename: Enrique A
authors.initials: EA
authors.lastname: Sabater
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Sems
authors.forename: W Matthew
authors.initials: WM
authors.lastname: Vassy
authors.forename: Julie L
authors.initials: JL
authors.lastname: Wynne
mesh_terms: D002423:Cause of Death; D004621:Embolization, Therapeutic / Q000379:methods; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006488:Hemostasis, Surgical / Q000379:methods; D006489:Hemostatic Techniques; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010384:Pelvic Bones / Q000293:injuries*; D017410:Practice Guidelines as Topic; D011859:Radiography; D018570:Risk Assessment; D012955:Societies, Medical; D016019:Survival Analysis; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy