title: Current management of hemorrhage from severe pelvic fractures: Results of an American Association for the Surgery of Trauma multi-institutional trial.
abstract: BACKGROUND
  There is no consensus as to the optimal treatment paradigm for patients presenting with hemorrhage from severe pelvic fracture. This study was established to determine the methods of hemorrhage control currently being used in clinical practice.
  
  
  METHODS
  This prospective, observational multi-center study enrolled patients with pelvic fracture from blunt trauma. Demographic data, admission vital signs, presence of shock on admission (systolic blood pressure < 90 mm Hg or heart rate > 120 beats per minute or base deficit < -5), method of hemorrhage control, transfusion requirements, and outcome were collected.
  
  
  RESULTS
  A total of 1,339 patients with pelvic fracture were enrolled from 11 Level I trauma centers. Fifty-seven percent of the patients were male, with a mean ± SD age of 47.1 ± 21.6 years, and Injury Severity Score (ISS) of 19.2 ± 12.7. In-hospital mortality was 9.0 %. Angioembolization and external fixator placement were the most common method of hemorrhage control used. A total of 128 patients (9.6%) underwent diagnostic angiography with contrast extravasation noted in 63 patients. Therapeutic angioembolization was performed on 79 patients (5.9%). There were 178 patients (13.3%) with pelvic fracture admitted in shock with a mean ± SD ISS of 28.2 ± 14.1. In the shock group, 44 patients (24.7%) underwent angiography to diagnose a pelvic source of bleeding with contrast extravasation found in 27 patients. Thirty patients (16.9%) were treated with therapeutic angioembolization. Resuscitative endovascular balloon occlusion of the aorta was performed on five patients in shock and used by only one of the participating centers. Mortality was 32.0% for patients with pelvic fracture admitted in shock.
  
  
  CONCLUSIONS
  Patients with pelvic fracture admitted in shock have high mortality. Several methods were used for hemorrhage control with significant variation across institutions. The use of resuscitative endovascular balloon occlusion of the aorta may prove to be an important adjunct in the treatment of patients with severe pelvic fracture in shock; however, it is in the early stages of evaluation and not currently used widely across trauma centers.
  
  
  METHODS
  Prognostic study, level II; therapeutic study, level III.
authors.affiliation: From the Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery (T.W.C., R.Co.), Department of Surgery, University of California San Diego Health Sciences, San Diego; Department of Surgery, Loma Linda University Medical Center (R.Ca., A.B.), Loma Linda; Department of Surgery, University of Southern California (D.S., K.I.), Los Angeles; and Department of Surgery, San Francisco General Hospital and Trauma Center (A.P., R.C.M.), San Francisco, California; Department of Surgery, University of Texas Health Sciences Center-Houston (J.B.H., J.M.P.), Houston; Department of Surgery, East Texas Medical Center (L.W., J.C.), Tyler; and Department of Surgery, University of Texas Southwestern Medical Center (B.H.W., J.P.M.), Dallas, Texas; Department of Surgery, R Adams Cowley Shock Trauma Center (T.M.S., D.M.S.), Baltimore, Maryland; Department of Surgery, St. Luke's University Health Network (S.K., G.S.), Bethlehem; and Department of Surgery, University of Pittsburgh Medical Center (T.Z., J.S.), Pittsburgh, Pennsylvania; and Department of Surgery, Chandler Regional Medical Center (B.R.R., F.O.M), Chandler, Arizona.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Costantini
authors.forename: Raul
authors.initials: R
authors.lastname: Coimbra
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Podbielski
authors.forename: Richard
authors.initials: R
authors.lastname: Catalano
authors.forename: Allie
authors.initials: A
authors.lastname: Blackburn
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Stein
authors.forename: Lashonda
authors.initials: L
authors.lastname: Williams
authors.forename: Joseph
authors.initials: J
authors.lastname: Conflitti
authors.forename: Scott
authors.initials: S
authors.lastname: Keeney
authors.forename: Ghada
authors.initials: G
authors.lastname: Suleiman
authors.forename: Tianhua
authors.initials: T
authors.lastname: Zhou
authors.forename: Jason
authors.initials: J
authors.lastname: Sperry
authors.forename: Dimitra
authors.initials: D
authors.lastname: Skiada
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Brian H
authors.initials: BH
authors.lastname: Williams
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Minei
authors.forename: Alicia
authors.initials: A
authors.lastname: Privette
authors.forename: Robert C
authors.initials: RC
authors.lastname: Mackersie
authors.forename: Brenton R
authors.initials: BR
authors.lastname: Robinson
authors.forename: Forrest O
authors.initials: FO
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000328:Adult; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods; D050723:Fractures, Bone / Q000150:complications* / Q000628:therapy; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult