Impact of a Simplified Management Algorithm on Outcome Following Exsanguinating Pelvic Fractures: A 10-Year Experience

Background Optimal management of exsanguinating pelvic fractures remains controversial. Our previous experience suggested that management decisions based on a defined algorithm were associated with a significant reduction in transfusion requirements and mortality. Based on these outcomes, a clinical pathway for the management of exsanguinating pelvic fractures was developed. The purpose of this study was to evaluate the impact of this pathway on outcomes. Methods Consecutive patients over 10 years with blunt pelvic fractures subsequent to the implementation of the clinical pathway were identified. Patients with hemodynamically unstable pelvic fractures are managed initially with a pelvic orthotic device (POD). For those with continued hemodynamic instability and no extra-pelvic source of hemorrhage, pelvic angiography was performed followed by elective pelvic fixation. Patients managed according to the pathway (PW) were compared to those patients whose management deviated from the pathway (DEV). Results 3467 patients were identified. 312 (9%) met entry criteria: 246 (79%) comprised the PW group and 66 (21%) the DEV group. Injury severity, as measured by ISS (35 vs 36, p=0.55), admission GCS (10 vs 10, p=0.58), admission BE (-7.4 vs -6.4, p=0.38), admission SBP (107 vs 104, p=0.53), and PRBC requirements during initial resuscitation (6.1 vs 6.6 units, p=0.22) were similar between the groups. POD use was 48% in the DEV group (p

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