title: Improvement in institutional protocols leads to decreased mortality in patients with haemodynamically unstable pelvic fractures.
abstract: BACKGROUND
  The mortality rate in patients with haemodynamically unstable pelvic fractures is as high as 40-60%. In recent years, angioembolisation and pelvic packing have been introduced as part of a multimodality treatment for these patients. Protocol-driven management has been shown to improve outcomes.
  
  
  METHODS
  This is a Level III retrospective cohort study of patients suffering from unstable pelvic fractures from 1 January 1996 to 30 September 2011. The aim of the study was to review our results, particularly in terms of mortality through the evolution of three phases of treatment protocols: preangiography, angiography and pelvic packing.
  
  
  RESULTS
  The overall 30-day mortality rate for all patients was 47.2%, with a rate of 63.5% in the preangiography phase, 42.1% in the angiography phase and 30.6% in the pelvic packing phase. Multivariate logistic regression analysis identified the use of retroperitoneal packing as a significant independent predictive factor for 24 h mortality.
  
  
  CONCLUSIONS
  Our results showed an improvement in patient survival with sequential protocols over the study period, during which we incorporated a multidisciplinary approach to managing these complicated pelvic fractures. The results strongly suggest that retroperitoneal packing should be highly recommended for bleeding subsequent to pelvic fracture, in addition to other modalities of treatment.
authors: Department of Surgery, Queen Elizabeth Hospital, Hong Kong.
authors: Mina
authors: M
authors: Cheng
authors: Department of Surgery, Queen Elizabeth Hospital, Hong Kong.
authors: Moon-Tong
authors: MT
authors: Cheung
authors: Department of Surgery, Queen Elizabeth Hospital, Hong Kong.
authors: Kin-Yan
authors: KY
authors: Lee
authors: Department of Orthopaedics & Traumatology, Queen Elizabeth Hospital, Hong Kong.
authors: Kin-Bong
authors: KB
authors: Lee
authors: Department of Radiology & Imaging, Queen Elizabeth Hospital, Hong Kong.
authors: Susan-C H
authors: SC
authors: Chan
authors: Department of Anaesthesiology & Operating Theatre Services, Queen Elizabeth Hospital, Hong Kong.
authors: Amy-C Y
authors: AC
authors: Wu
authors: Department of Anaesthesiology & Operating Theatre Services, Queen Elizabeth Hospital, Hong Kong.
authors: Yu-Fat
authors: YF
authors: Chow
authors: Department of Accident & Emergency, Queen Elizabeth Hospital, Hong Kong.
authors: Annice-M L
authors: AM
authors: Chang
authors: Department of Accident & Emergency, Queen Elizabeth Hospital, Hong Kong.
authors: Hiu-Fai
authors: HF
authors: Ho
authors: Department of Management Sciences, City University of Hong Kong, Hong Kong.
authors: Kelvin-K W
authors: KK
authors: Yau
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D002985:Clinical Protocols / Q000592:standards*; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006439:Hemodynamics; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D012189:Retrospective Studies; D013630:Tampons, Surgical
keywords: Trauma, Spine and Pelvis