Treatment modalities of Hemorrhage control and mortality risk in unstable pelvic fractures

The mortality rate for patients with pelvic fractures has been studied extensively in the trauma literature, and most studies have placed it at 10%. Patients with pelvic fracture who required at least 4 units of blood transfusion and 1 significant hemorrhage control intervention were included in a recently published research that looked at their long-term prognosis.

Preperitoneal pelvic packing is associated with a greater risk of complications and a high overall mortality rate (36%), whereas angioembolization (AE) is associated with a decreased mortality rate (PP).

Patients with significant injuries to parts of the body other than the pelvis were also included in the study.

The authors performed a sensitivity analysis, excluding the subset of patients with an Abbreviated Injury Severity score of 2 or greater for head or chest, and confirmed their findings. The inclusion of these patients with a median Injury Severity Score of 24 may explain the high mortality rate and the median of 9 units of blood transfused. An independent risk of death has been linked to pelvic fractures in the context of other serious injuries, as shown by previous research. Perhaps most importantly, the authors show that there is substantial variation in the management of these critically ill patients across the United States, particularly in the choice and combination of interventions used, such as aortic endovascular balloon angioplasty (AE), preperitoneal PP, and resuscitative endovascular balloon angioplasty (REBOA).

This population-based research may have residual confounding, and patients who receive preperitoneal PP are physiologically different from those who can wait for the interventional radiology team, but the obvious issue from these findings is: what can we do to better rescue these patients and lower their high fatality rate?

The most noteworthy discovery of this research is the wide range of hospital management approaches. This variant warrants more investigation. Literature demonstrates that variance in procedures of care typically reflects variation in the quality of care offered, even if some variation is always necessary to provide patient-centered, tailored care.