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Severe Bleeding in Pelvic Fractures: Considerations in Planning Damage Control.

Abstract Severe bleeding due to pelvic fractures may require damage control procedures, such as preperitoneal packing. In many cases, preperitoneal packing is performed without full abdominal exploration. There are concerns that such an approach may miss major iliac vascular injuries or other intraabdominal injuries. This analysis assessed the incidence of iliac vascular and intraabdominal injuries in patients with pelvic fractures. The National Trauma Data Bank was queried for blunt trauma patients. Patients with severe pelvic fractures were observed. Common or external iliac vascular lacerations (CEIVL) and associated intraabdominal injuries were recorded. The study comprised 42,122 patients with pelvic fractures, of which 3,221 (7.6%) were severe pelvic fractures. The incidence of CEIVL in patients with severe pelvic fractures was 10.7 per cent. Patient age greater than or equal to 65 years was an independent predictor of CEIVL. A total of 34.3 per cent of severe pelvic fracture patients had severe associated intraabdominal injuries, including injuries to the bladder (26.5%) and bowel (16.7%). Severe pelvic fractures are associated with a high incidence of iliac vascular and intraabdominal injuries. Preperitoneal pelvic packing without abdominal exploration may miss these injuries.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the american surgeon
Publication Year Start




PMID- 29580357
OWN - NLM
STAT- MEDLINE
DCOM- 20180404
LR  - 20180404
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 84
IP  - 2
DP  - 2018 Feb 1
TI  - Severe Bleeding in Pelvic Fractures: Considerations in Planning Damage Control.
PG  - 267-272
AB  - Severe bleeding due to pelvic fractures may require damage control procedures,
      such as preperitoneal packing. In many cases, preperitoneal packing is performed 
      without full abdominal exploration. There are concerns that such an approach may 
      miss major iliac vascular injuries or other intraabdominal injuries. This
      analysis assessed the incidence of iliac vascular and intraabdominal injuries in 
      patients with pelvic fractures. The National Trauma Data Bank was queried for
      blunt trauma patients. Patients with severe pelvic fractures were observed.
      Common or external iliac vascular lacerations (CEIVL) and associated
      intraabdominal injuries were recorded. The study comprised 42,122 patients with
      pelvic fractures, of which 3,221 (7.6%) were severe pelvic fractures. The
      incidence of CEIVL in patients with severe pelvic fractures was 10.7 per cent.
      Patient age greater than or equal to 65 years was an independent predictor of
      CEIVL. A total of 34.3 per cent of severe pelvic fracture patients had severe
      associated intraabdominal injuries, including injuries to the bladder (26.5%) and
      bowel (16.7%). Severe pelvic fractures are associated with a high incidence of
      iliac vascular and intraabdominal injuries. Preperitoneal pelvic packing without 
      abdominal exploration may miss these injuries.
FAU - Cho, Jayun
AU  - Cho J
FAU - Benjamin, Elizabeth
AU  - Benjamin E
FAU - Inaba, Kenji
AU  - Inaba K
FAU - Lam, Lydia
AU  - Lam L
FAU - Demetriades, Demetrios
AU  - Demetriades D
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
SB  - IM
MH  - Abdominal Injuries/complications/*diagnosis/epidemiology/therapy
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Fractures, Bone/*complications
MH  - Hemorrhage/diagnosis/epidemiology/*etiology/therapy
MH  - Hemostatic Techniques
MH  - Humans
MH  - Iliac Artery/injuries
MH  - Iliac Vein/injuries
MH  - Incidence
MH  - Laparotomy
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Multiple Trauma/complications/*diagnosis/epidemiology/therapy
MH  - Pelvic Bones/*injuries
MH  - Severity of Illness Index
MH  - Vascular System Injuries/complications/*diagnosis/epidemiology/therapy
MH  - Wounds, Nonpenetrating/complications/*diagnosis/epidemiology/therapy
MH  - Young Adult
EDAT- 2018/03/28 06:00
MHDA- 2018/04/05 06:00
CRDT- 2018/03/28 06:00
PHST- 2018/03/28 06:00 [entrez]
PHST- 2018/03/28 06:00 [pubmed]
PHST- 2018/04/05 06:00 [medline]
PST - ppublish
SO  - Am Surg. 2018 Feb 1;84(2):267-272.