Operating room or angiography suite for hemodynamically unstable pelvic fractures?

Chad M. Thorson, Mark L. Ryan, Christian A. Otero, Thai Vu, Maria J. Borja, Jean Jose, Carl I. Schulman, Alan S. Livingstone, Kenneth G. Proctor

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

BACKGROUND: Few patients require angiography and therapeutic embolization for bleeding pelvic fractures, but they are risk for significant morbidity and mortality. In hemodynamically unstable trauma patients with pelvic fractures, the decision to proceed to the operating room (OR) to address intraabdominal bleeding, or angiography to address pelvic bleeding (ANGIO), is rarely straightforward. This study tested the hypothesis that outcomes are similar regardless if the sequence was OR-ANGIO or ANGIO-OR. METHODS: All pelvic fractures between 1999 and 2011 were retrospectively reviewed and stratified by initial management with ANGIO or OR. RESULTS: Of 2,922 patients with pelvic fractures, only 183 (6%) required angiography for suspected bleeding. For OR-ANGIO (n = 49) versus ANGIO (n = 134), injury severity score was similar (40 ± 15 vs. 35 ± 16), but systolic blood pressure (97 ± 28 vs. 108 ± 32 mmHg, p = 0.038) and base excess were both lower (-9 ± 5 vs. -5 ± 5 mEq/L, p < 0.001). During initial resuscitation and in the first 24 hours, crystalloid, blood product usage and total fluid requirements were all increased 50% to 100% (all p < 0.001). Despite these differences, lengths of stay (32 ± 32 vs. 26 ± 28 days) and mortality (33% vs. 31%) were similar. The same trends in fluid requirements remained in the subset of patients with unstable pelvic fractures, with an increased mortality (67% vs. 20%, p = 0.011) in those requiring ANGIO-OR versus OR-ANGIO. CONCLUSION: These data support current management algorithms. In hemodynamically unstable trauma patients with pelvic fractures, those who proceeded immediately to the OR to address intraabdominal bleeding tended to be sicker but had outcomes that were the same or better compared with those who received angiography to address pelvic bleeding.

Original languageEnglish (US)
Pages (from-to)364-372
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume72
Issue number2
DOIs
StatePublished - Feb 1 2012
Externally publishedYes

Keywords

  • Angiography
  • Exploratory laparotomy
  • Intraabdominal hemorrhage
  • Pelvic fracture
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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  • Cite this

    Thorson, C. M., Ryan, M. L., Otero, C. A., Vu, T., Borja, M. J., Jose, J., Schulman, C. I., Livingstone, A. S., & Proctor, K. G. (2012). Operating room or angiography suite for hemodynamically unstable pelvic fractures? Journal of Trauma and Acute Care Surgery, 72(2), 364-372. https://doi.org/10.1097/TA.0b013e318243da10