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Prospective validation of a new protocol with preperitoneal pelvic packing as the mainstay for the treatment of hemodynamically unstable pelvic trauma: a 5-year experience

  • Stefano MagnoneEmail author
  • Niccolò Allievi
  • Marco Ceresoli
  • Federico Coccolini
  • Michele Pisano
  • Luca Ansaloni
Original Article
  • 36 Downloads

Abstract

Purposes

Hemodynamically unstable pelvic trauma has been a significant challenge even in most experienced Trauma Centres. In 2011 preperitoneal pelvic packing (PPP) was introduced in our Hospital as the first manoeuvre. This study aims to review overall mortality at 24 h from arrival in the emergency department.

Methods

A retrospective review of our prospective database was performed considering patients with systolic blood pressure (SBP) < 90 mmHg or with the need for more than 2 Units of packed red blood cells (PRBC) on admission in the emergency department, (ED) and a pelvic fracture. Values were expressed as a median and interquartile range. Continuous variables were compared with the Mann–Whitney test.

Results

Between September 2011 and December 2016, we treated 30 patients. Median age was 51 years (40–65) and Injury Severity Score 36 (34–42). SBP in the ED was 90 (67–99), heart rate was 115 (90–130), Base Excess − 8 (− 11.5/− 4.8), pH 7.23 (7.20–7.28). Median PRBC requirements during the first 24 h (from admission) were 13 Units (8–18.8). Time to emergency treatment was 63 min (51–113). 17 patients (56.6%) underwent angiography after PPP. Overall 24 h mortality was 30%. A comparison between survivors and non-survivors showed no statistically significant differences between groups.

Conclusions

In our experience, PPP resulted to be quick to perform and effective. No death occurred from direct pelvic bleeding.

Keywords

Preperitoneal pelvic packing Pelvic trauma Angiography 

Notes

Acknowledgements

We are indebted with Carlotta Galeno for her help in retrieving data.

Author contributions

Study conception and design: SM. Acquisition of data: SM, MC, NA. Analysis and interpretation of data: SM. Drafting of the manuscript: SM. Critical Revision and consent for publication: all authors.

Funding

No financial support was given for this study.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.General Surgery IOspedale Papa Giovanni XXIIIBergamoItaly

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