Therapeutical Strategies and Outcome of Polytraumatized Patients with Pelvic Injuries A Six-Year Experience

Abstract

The combination of multiple injuries and pelvic ring disruption often represents a devastating injury pattern. This study evaluates therapeutical strategies and the outcome of 174 severely traumatized patients with pelvic ring injury (ISS: 32.1±11.1 patients) over a 6-year period. Patients were divided into 3 groups according to their hemodynamic status at admission. Forty-one patients in extremis (group A; ISS: 40.1±11.1 patients) which required the highest resuscitation efforts revealed a mortality rate of 90%. Many of these patients underwent crash laparotomy (44%)/thoracotomy (22%), aortic clamping (22%), and pelvic packing (44%). Patients with persistent hemodynamic instability (group B; n = 39; ISS: 34.2±9.6 patients) had a mortality rate of 26% (p<0.05 versus group A) with 14 patients (36%) undergoing emergency laparotomy. Mortality rate (5%) markedly (p<0.05) decreased in patients with stable hemodynamics despite a relatively high ISS (group C; n = 94; ISS: 27.6±9.4 patients). Hemorrhage could be controlled in all patients of group B and C, while 23 out of 41 patients (56%) in extremis died due to exsanguination during the first 24 hours after injury. Thus, treatment of patients in extremis must be focused on aggressive resuscitation and surgical intervention without extensive diagnostic procedures to effectively control lethal hemorrhage.