Eastern association for the surgery of trauma practice management guidelines for hemorrhage in pelvic fracture-update and systematic review

Daniel C. Cullinane, Henry J. Schiller, Martin D. Zielinski, Jaroslaw W. Bilaniuk, Bryan R. Collier, John Como, Michelle Holevar, Enrique A. Sabater, S. Andrew Sems, W. Matthew Vassy, Julie L. Wynne

Research output: Contribution to journalArticle

129 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1850-1868
Number of pages19
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume71
Issue number6
DOIs
StatePublished - Dec 2011

Fingerprint

Practice Management
Practice Guidelines
Hemorrhage
Wounds and Injuries
Guidelines
External Fixators
Nonpenetrating Wounds
Angiography
Retrospective Studies
Prospective Studies
Morbidity
Mortality

Keywords

  • Angiography
  • Blush
  • C-clamp
  • CT scan
  • Embolization
  • External fixator
  • FAST
  • Fracture pattern
  • Hemorrhage
  • Intravenous contrast extravasation
  • PASG
  • Pelvic fracture
  • Pelvic hematoma
  • Pelvic packing
  • Temporary pelvic binder
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Eastern association for the surgery of trauma practice management guidelines for hemorrhage in pelvic fracture-update and systematic review. / Cullinane, Daniel C.; Schiller, Henry J.; Zielinski, Martin D.; Bilaniuk, Jaroslaw W.; Collier, Bryan R.; Como, John; Holevar, Michelle; Sabater, Enrique A.; Sems, S. Andrew; Vassy, W. Matthew; Wynne, Julie L.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 71, No. 6, 12.2011, p. 1850-1868.

Research output: Contribution to journalArticle

Cullinane, DC, Schiller, HJ, Zielinski, MD, Bilaniuk, JW, Collier, BR, Como, J, Holevar, M, Sabater, EA, Sems, SA, Vassy, WM & Wynne, JL 2011, 'Eastern association for the surgery of trauma practice management guidelines for hemorrhage in pelvic fracture-update and systematic review', Journal of Trauma - Injury, Infection and Critical Care, vol. 71, no. 6, pp. 1850-1868. https://doi.org/10.1097/TA.0b013e31823dca9a
Cullinane, Daniel C. ; Schiller, Henry J. ; Zielinski, Martin D. ; Bilaniuk, Jaroslaw W. ; Collier, Bryan R. ; Como, John ; Holevar, Michelle ; Sabater, Enrique A. ; Sems, S. Andrew ; Vassy, W. Matthew ; Wynne, Julie L. / Eastern association for the surgery of trauma practice management guidelines for hemorrhage in pelvic fracture-update and systematic review. In: Journal of Trauma - Injury, Infection and Critical Care. 2011 ; Vol. 71, No. 6. pp. 1850-1868.
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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.",
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AU - Schiller, Henry J.

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AU - Bilaniuk, Jaroslaw W.

AU - Collier, Bryan R.

AU - Como, John

AU - Holevar, Michelle

AU - Sabater, Enrique A.

AU - Sems, S. Andrew

AU - Vassy, W. Matthew

AU - Wynne, Julie L.

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KW - PASG

KW - Pelvic fracture

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KW - Temporary pelvic binder

KW - Trauma

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