Management guidelines for hypotensive pelvic fracture patients

Pelvic fractures are common in blunt trauma patients and are often associat ed with other system injuries. Most studies describe the type of pelvic fra ctures and classify them by the forces creating the injury. Mortality from these fractures is due most often to other system injuries or to hemorrhage , Mortality ranges from 5 to 20 per cent depending on complexity and number of systems injured. We studied 692 cases of pelvic fractures and analyzed the seriously ill patients. They were identified by blood pressure (BP) les s than 90 systolic on presentation to the trauma room and having a complex pelvic fracture. The management of these patients was by a protocol used by a group of eight trauma surgeons, This group of 75 hypotensive pelvic frac ture patients were analyzed to identify significant factors in their manage ment that predicted mortality. Patients with base excess (BE) values less t han or equal to-5 were significantly more likely to die (P < 0.05), Patient s with BP less than or equal to 90 on leaving the trauma room had a signifi cantly higher mortality (P < 0.01). Injury Severity Score predicted mortali ty and can be useful as a tool for quality assurance and process improvemen t, The early operative intervention to fix associated fractures within 24 h ours was not detrimental to patient outcome. Overall mortality in this very sick population was 14.7 per cent. Emergent angiography was used successfu lly on 14 patients. Seven patients died of continued bleeding. The most imp ortant management guidelines for these seriously injured, complex patients are: 1) resuscitate with BE used as a monitor; 2) keep patient blood volume as close to normal as possible; 3) use BP, BE, and ISS to evaluate managem ent of these patients.