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Priorities in Management

B. Mark Evers, MD; Henry M. Cryer, MD; Frank B. Miller, MD

Arch Surg. 1989;124(4):422-424.

Abstract
• Hemorrhage remains the leading cause of mortality in patients with severe pelvic fractures. To evaluate diagnostic and treatment priorities for this problem, we retrospectively reviewed 245 consecutive patients admitted to our institution with pelvic fractures. Supraumbilical diagnostic peritoneal lavage (DPL) was grossly positive in 27 patients, and eight (30%) of these had life-threatening intra-abdominal hemorrhage identified at laparotomy. No patient with a positive DPL by count alone had life-threatening intra-abdominal hemorrhage. Pelvic fracture stabilization with early external pelvic fixation was associated with less requirement for blood transfusion (10±1 U) than with the pneumatic antishock garment (17±3 U). Nine patients with pelvic arterial injuries underwent angiographic embolization, and eight patients died (89%). We conclude that pelvic angiography should be performed before laparotomy in hemodynamically unstable patients with pelvic fracture, unless the DPL is grossly positive.

(Arch Surg 1989;124:422-424)

Author Affiliations
From the Department of Surgery, University of Louisville School of Medicine.

Footnotes
Accepted for publication Nov 7, 1988.

Read before the 12th Annual Surgical Symposium of the Association of Veterans Administration Surgeons, Minneapolis, May 13, 1988.

Reprint requests to Department of Surgery, University of Louisville, Louisville, KY 40292 (Dr Cryer).

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