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Acute management and outcome of multiple trauma patients with pelvic disruptions

Markus Burkhardt1*, Ulrike Nienaber2, Antonius Pizanis1, Marc Maegele3, Ulf Culemann1, Bertil Bouillon3, Sascha Flohé4, Tim Pohlemann1, Thomas Paffrath3 and the TraumaRegister DGU and the German Pelvic Injury Register of the Deutsche Gesellschaft für Unfallchirurgie

Author Affiliations

1 Department of Trauma, Hand and Reconstructive Surgery, University of Saarland, Kirrbergerstr. 100, 66421 Homburg/Saar, Germany

2 AUC-Academy of Trauma Surgery, Landwehrstr. 34, 80336 Munich, Germany

3 Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Centre (CMMC), Ostmerheimerstr. 200, 51109 Cologne, Germany

4 Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany

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Critical Care 2012, 16:R163  doi:10.1186/cc11487

Published: 22 August 2012

Abstract

Introduction

Data on prehospital and trauma-room fluid management of multiple trauma patients with pelvic disruptions are rarely reported. Present trauma algorithms recommend early hemorrhage control and massive fluid resuscitation. By matching the German Pelvic Injury Register (PIR) with the TraumaRegister DGU (TR) for the first time, we attempt to assess the initial fluid management for different Tile/OTA types of pelvic-ring fractures. Special attention was given to the patient's posttraumatic course, particularly intensive care unit (ICU) data and patient outcome.

Methods

A specific match code was applied to identify certain patients with pelvic disruptions from both PIR and TR anonymous trauma databases, admitted between 2004 and 2009. From the resulting intersection set, a retrospective analysis was done of prehospital and trauma-room data, length of ICU stay, days of ventilation, incidence of multiple organ dysfunction syndrome (MODS), sepsis, and mortality.

Results

In total, 402 patients were identified. Mean ISS was 25.9 points, and the mean of patients with ISS ≥16 was 85.6%. The fracture distribution was as follows: 19.7% type A, 29.4% type B, 36.6% type C, and 14.3% isolated acetabular and/or sacrum fractures. The type B/C, compared with type A fractures, were related to constantly worse vital signs that necessitated a higher volume of fluid and blood administration in the prehospital and/or the trauma-room setting. This group of B/C fractures were also related to a significantly higher presence of concomitant injuries and related to increased ISS. This was related to increased ventilation and ICU stay, increased rate of MODS, sepsis, and increased rate of mortality, at least for the type C fractures. Approximately 80% of the dead had sustained type B/C fractures.

Conclusions

The present study confirms the actuality of traditional trauma algorithms with initial massive fluid resuscitation in the recent therapy of multiple trauma patients with pelvic disruptions. Low-volume resuscitation seems not yet to be accepted in practice in managing this special patient entity. Mechanically unstable pelvic-ring fractures type B/C (according to the Tile/OTA classification) form a distinct entity that must be considered notably in future trauma algorithms.