Clinical outcomes of blood transfusion to patients with pelvic fracture in the initial 6 h from injury

Yang,Qing; Wang,Ting; Ai,Lei; Jiang,Kai; Tao,Xingguang; Gong,Dongliang; Chen,Nong; Fu,Yang; Pan,Fugen

doi:10.3892/etm.2020.8445

March-2020 Volume 19 Issue 3

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March-2020 Volume 19 Issue 3

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Article Open Access

Clinical outcomes of blood transfusion to patients with pelvic fracture in the initial 6 h from injury

Authors:
- Qing Yang
- Ting Wang
- Lei Ai
- Kai Jiang
- Xingguang Tao
- Dongliang Gong
- Nong Chen
- Yang Fu
- Fugen Pan
View Affiliations / Copyright

Affiliations: Department of Orthopedics, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Qingpu District Central Hospital of Shanghai, Shanghai 201700, P.R. China, Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 201600, P.R. China, Department of Laboratory, Taishan Coal Sanatorium, Taian, Shangdong 201700, P.R. China

Copyright: © Yang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Pages: 2252-2258
|
Published online on: January 10, 2020

https://doi.org/10.3892/etm.2020.8445
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Abstract

As part of the treatment of pelvic fracture, major hemorrhage poses a challenge for trauma surgeons. The aim of the present study was to evaluate the clinical outcomes of blood transfusion in the initial 6 h after pelvic fracture, and to define the blood transfusion volume required for each pelvic fracture type. A retrospective cohort study was performed on patients with pelvic fracture at a single Level I Trauma Centre over a 3‑year period. A total of 1,297 patients were transported to our trauma centre within 2 h of injury and blood transfusion was administered in the initial 6 h after pelvic fracture. Review of the patients' medical records provided the initial pelvic radiographs and data from emergency department care. Clinical outcomes, including frequency of blood transfusion, blood transfusion volume, injury severity scores and mortality, were evaluated. All pelvic fractures were defined as closed fractures and patients were categorized according to the Arbeit fuer Osteosynthese (AO) classification system. Statistical methods were used to identify trends to provide guidance for clinical prediction. Complete data were available for 497 patients with pelvic fracture, 104 (20.9%) of which received blood transfusion. The blood transfusion volume in the initial 6 h ranged from 0 to 10,000 ml, with a mean of 1,213.94±1354.11 ml. The total mortality rate was 1.8%. Among the patients with C‑type pelvic fractures, the frequency of blood transfusion was 59.0% and the mean volume was 2,191.30±1,740.93 ml. The mortality rate for C‑type pelvic fractures was 11.43%. The B3 subtype of pelvic fractures had the highest transfusion frequency (53.6%), while the C3 subtype had the largest blood transfusion volume (5,700.00±4,666.90 ml). Patients with type A‑C pelvic fractures had a progressively larger mean transfusion volume, transfusion frequency and mortality in the initial 6 h after pelvic fracture. The AO classification system was demonstrated to be a useful tool for the identification of pelvic fracture risk in the present study.

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1	Paydar S, Chaabi M, Akhavan M, Ghahramani Z and Dehghankhalili M: Outcome determinants of patients with traumatic pelvic fractures: A cohort study in a level i trauma center in southern iran. Malays Orthop J. 11:23–30. 2017. View Article : Google Scholar : PubMed/NCBI
2	Rehwald R, Schönherr E, Petersen J, Jeske HC, Fialkovska A, Luger AK, Grams AE, Loizides A, Jaschke W and Glodny B: Prognostic factors in endovascular treated pelvic haemorrhage after blunt trauma. BMC Surg. 17:892017. View Article : Google Scholar : PubMed/NCBI
3	Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS Jr, Poka A, Bathon GH and Brumback RJ: Pelvic ring disruptions: Effective classification system and treatment protocols. J Trauma. 30:848–856. 1990. View Article : Google Scholar : PubMed/NCBI
4	Starr AJ, Griffin DR, Reinert CM, Frawley WH, Walker J, Whitlock SN, Borer DS, Rao AV and Jones AL: Pelvic ring disruptions: Prediction of associated injuries, transfusion requirement, pelvic arteriography, complications, and mortality. J Orthop Trauma. 16:553–561. 2002. View Article : Google Scholar : PubMed/NCBI
5	Dalal SA, Burgess AR, Siegel JH, Young JW, Brumback RJ, Poka A, Dunham CM, Gens D and Bathon H: Pelvic fracture in multiple trauma: Classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma. 29:981–1002. 1989. View Article : Google Scholar : PubMed/NCBI
6	Papadopoulos IN, Kanakaris N, Bonovas S, Triantafillidis A, Garnavos C, Voros D and Leukidis C: Auditing 655 fatalities with pelvic fractures by autopsy as a basis to evaluate trauma care. J Am Coll Surg. 203:30–43. 2006. View Article : Google Scholar : PubMed/NCBI
7	Chen TW, Yang ZG, Dong ZH, Tang SS, Chu ZG and Shao H: Earthquake-related pelvic crush fracture vs. non-earthquake fracture on digital radiography and MDCT: A comparative study. Clinics (Sao Paulo). 66:629–634. 2011. View Article : Google Scholar : PubMed/NCBI
8	Eastridge BJ, Starr A, Minei JP, O'Keefe GE and Scalea TM: The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma. 53:446–451. 2002. View Article : Google Scholar : PubMed/NCBI
9	Vaidya R, Waldron J, Scott A and Nasr K: Angiography and embolization in the management of bleeding pelvic fractures. J Am Acad Orthop Surg. 26:e68–e76. 2018. View Article : Google Scholar : PubMed/NCBI
10	Hussami M, Grabherr S, Meuli RA and Schmidt S: Severe pelvic injury: Vascular lesions detected by ante- and post-mortem contrast medium-enhanced CT and associations with pelvic fractures. Int J Legal Med. 131:731–738. 2017. View Article : Google Scholar : PubMed/NCBI
11	Burlew CC, Moore EE, Stahel PF, Geddes AE, Wagenaar AE, Pieracci FM, Fox CJ, Campion EM, Johnson JL and Mauffrey C: Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. J Trauma Acute Care Surg. 82:233–242. 2017. View Article : Google Scholar : PubMed/NCBI
12	Magnussen RA, Tressler MA, Obremskey WT and Kregor PJ: Predicting blood loss in isolated pelvic and acetabular high-energy trauma. J Orthop Trauma. 21:603–607. 2007. View Article : Google Scholar : PubMed/NCBI
13	Blackmore CC, Jurkovich GJ, Linnau KF, Cummings P, Hoffer EK and Rivara FP: Assessment of amount of hemorrhage and outcome from pelvic fracture. Arch Surg. 138:504–509. 2003. View Article : Google Scholar : PubMed/NCBI
14	Blackmore CC, Cummings P, Jurkovich GJ, Linnau KF, Hoffer EK and Rivara FP: Predicting major hemorrhage in pelvic fracture. J Trauma. 61:346–352. 2006. View Article : Google Scholar : PubMed/NCBI
15	Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B and Audigé L: Fracture and dislocation classification compendium −2007: Orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma. 21 (10 Suppl):S1–S133. 2007. View Article : Google Scholar : PubMed/NCBI
16	Association for the Advancement of Automotive Medicine (AAAM), . The abbreviated injury scale (AIS)-1990 revision. AAAM. (Chicago, IL). 11–15. 1990.
17	Baker SP, O'Neill B, Haddon W Jr and Long WB: The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 14:187–196. 1974. View Article : Google Scholar : PubMed/NCBI
18	American College of Surgeons Committee on Trauma, . Advanced Trauma Life Support for Doctors. American College of Surgeons. (Chicago, IL). 2004.
19	Lal DS and Shaz BH: Massive transfusion: Blood component ratios. Curr Opin Hematol. 20:521–525. 2013. View Article : Google Scholar : PubMed/NCBI
20	Miller PR, Moore PS, Mansell E, Meredith JW and Chang MC: External fixation or arteriogram in bleeding pelvic fracture: Initial therapy guided by markers of arterial hemorrhage. J Trauma. 54:437–443. 2003. View Article : Google Scholar : PubMed/NCBI
21	Tang CH, Shivji F and Forward D: Major haemorrhage in pubic rami fractures. BMJ Case Rep. bcr20142080882015. View Article : Google Scholar : PubMed/NCBI
22	Hamill J, Holden A, Paice R and Civil I: Pelvic fracture pattern predicts pelvic arterial hemorrhage. Aust N Z J Surg. 70:338–343. 2000. View Article : Google Scholar : PubMed/NCBI
23	Barratt RC, Bernard J, Mundy AR and Greenwell TJ: Pelvic fracture urethral injury in males-mechanisms of injury, management options and outcomes. Transl Androl Urol. 7 (Suppl 1):S29–S62. 2018. View Article : Google Scholar : PubMed/NCBI
24	Jang JY, Shim H, Jung PY, Kim S and Bae KS: Preperitoneal pelvic packing in patients with hemodynamic instability due to severe pelvic fracture: Early experience in a Korean trauma center. Scand J Trauma Resusc Emerg Med. 24:32016. View Article : Google Scholar : PubMed/NCBI
25	Sarin EL, Moore JB, Moore EE, Shannon MR, Ray CE, Morgan SJ and Smith WR: Pelvic fracture pattern does not always predict the need for urgernt embolization. J Trauma. 58:973–977. 2005. View Article : Google Scholar : PubMed/NCBI
26	Osterhoff G, Scheyerer MJ, Fritz Y, Bouaicha S, Wanner GA, Simmen HP and Werner CM: Comparing the predictive value of the pelvic ring injury classification systems by Tile and by Young and Burgess. Injury. 45:742–747. 2014. View Article : Google Scholar : PubMed/NCBI
27	Gustavo Parreira J, Coimbra R, Rasslan S, Oliveira A, Fregoneze M and Mercadante M: The role of associated injuries on outcome of blunt trauma patients sustaining pelvic fractures. Injury. 31:677–682. 2000. View Article : Google Scholar : PubMed/NCBI
28	Hasankhani EG and Omidi-Kashani F: Treatment outcomes of open pelvic fractures associated with extensive perineal injuries. Clin Orthop Surg. 5:263–268. 2013. View Article : Google Scholar : PubMed/NCBI
29	Coccolini F, Stahel PF, Montori G, Biffl W, Horer TM, Catena F, Kluger Y, Moore EE, Peitzman AB, Ivatury R, et al: Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 12:52017. View Article : Google Scholar : PubMed/NCBI
30	Jovanovic B, Milan Z, Djuric O, Markovic-Denic L, Karamarkovic A, Gregoric P, Doklestic K, Avramovic J, Velickovic J and Bumbasirevic V: Twenty-eight-day mortality of blunt traumatic brain injury and co-injuries requiring mechanical ventilation. Med Princ Pract. 25:435–441. 2016. View Article : Google Scholar : PubMed/NCBI