Abstract
IntroductionPelvic fractures can result in life-threatening hemorrhages. Therefore, pelvic fracture patients must usually be transferred to a trauma center for additional management. We attempted to analyze transferred pelvic fracture patients to determine which diagnostic modalities to use in different treatment settings.Materials and methodsFrom May 1, 2008, to February 28, 2014, patients with pelvic fractures who were transferred from other local hospitals within 24 hours after the trauma were enrolled. We compared the pre-transfer conditions and pelvic X-ray results from the local hospitals between the group of patients that underwent further angioembolization at the trauma center and the group that did not. The role of computed tomography (CT) in the decision-making process (i.e., regarding additional angioembolization) at the different institutions was discussed.ResultsIn total, 751 patients were enrolled in the current study. Of the patients who received further angioembolization at the trauma center, 77.6 % (121/156) had sacro-iliac (SI) joint disruption on their pre-transfer pelvic X-ray; this rate was significantly higher than that of the patients who did not undergo further embolization (77.6 % vs. 25.5 %, p < 0.001). There was no significant difference in the use of pre-transfer CT scans at the local hospitals between the patients who underwent angioembolization and those who did not (53.8 % vs. 50.3 %, p = 0.472). Furthermore, of these patients, there was no significant difference in the length of emergency department stay (from arrival to angioembolization) at the trauma center among the patients who underwent pre-transfer CT scans and those who did not (97.4 ± 69.3 minutes vs. 108.6 ± 21.8 minutes, p = 0.461).ConclusionWhen managing patients with pelvic fractures, the more attention should be paid to those with SI joint disruption on pelvic X-ray. Because these patients are more likely to require further angioembolization, they should be transferred earlier. Additional CT may be performed after the patient’s transfer to the trauma center to determine subsequent treatment.
Highlights
Pelvic fractures can result in life-threatening hemorrhages
Of these patients, there was no significant difference in the length of emergency department stay at the trauma center among the patients who underwent pre-transfer computed tomography (CT) scans and those who did not (97.4 ± 69.3 minutes vs. 108.6 ± 21.8 minutes, p = 0.461)
During a pelvic fracture evaluation, it is usually necessary to transfer the patient to a trauma center for additional evaluation and management if he/she first seen at a local hospital with limited resources
Summary
Pelvic fracture patients must usually be transferred to a trauma center for additional management. We attempted to analyze transferred pelvic fracture patients to determine which diagnostic modalities to use in different treatment settings. During the management of patients with pelvic fractures at local hospitals, the early identification of. In the evaluation of blunt-trauma patients, primary pelvic X-ray has been usually accepted as an early diagnostic tool and is recommended by the Advanced Trauma Life Support protocol. We analyzed these transferred patients to delineate the role of primary pelvic X-rays at local hospitals. We attempted to identify accessible primary pelvic X-ray findings that indicate a need for further treatment according to the primary evaluations in the local hospitals. The selection of the diagnostic modalities used at institutions for patients with pelvic fractures was discussed
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