Source of bleeding in trauma patients with pelvic fracture and haemodynamic instability

• Published in: Cirugia Española Vol. 93; no. 7; p. 450
• Main Authors: Montmany, Sandra, Rebasa, Pere, Luna, Alexis, Hidalgo, José M, Cánovas, Gabriel, Navarro, Salvador
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01-08-2015
• Subjects: Female; Fractures, Bone - complications; Fractures, Bone - physiopathology; Hemodynamics; Hemorrhage - etiology; Hemorrhage - physiopathology; Humans; Male; Middle Aged; Multiple Trauma - complications; Multiple Trauma - physiopathology; Pelvic Bones - injuries; Prospective Studies; Fractura de pelvis; Pelvic fracture; Hemodynamic instability; Mechanism of action; Trauma patients; Mecanismo de acción; Inestabilidad hemodinámica; Pacientes politraumáticos
• ISSN: 1578-147X
• DOI: 10.1016/j.ciresp.2015.01.011

The main cause of mortality in trauma patients with pelvic fractures is hypovolemic shock. We analyzed the association between the source of bleeding, mechanism of action and type of fracture.
Prospective descriptive study involving trauma patients older than 16 years old, admitted to the intensive care unit or dead before admission, with pelvic fractures and hemodynamic instability. Hemodynamic instability was defined as SBP <90 and/or HR> 100 beats/min. Pelvic fracture was defined by the Tile classification.
A total of 157 of 1088 trauma patients had pelvic fracture. We included 63 patients, all hemodynamically unstable. A total of 85% of pelvic fractures after falls from great heights bled from the fracture itself, compared to only 44% of victims of impact (hit). A total of 65% of patients with stable pelvic fracture bled from associated lesions; 70% of patients with unstable fracture bled from the fracture itself. There is an interaction between the mechanism of action and type of fracture. The probability of pelvic bleeding is higher in the precipitated patient (> 80%) regardless of the type of fracture. Bleeding from associated injuries is greater in impact victims, doubling when the fracture is stable (91%).
Mechanism of action is a key to determine the source of bleeding in patients with pelvic fracture. After falls patients bleed from the fracture itself, while patients with an impact (hit) can bleed both from the fracture and associated injuries, depending on the type of fracture.