骨盆骨折类型可预测出血控制干预的必要性——美国创伤外科学会多机构研究结果
Pelvic fracture pattern predicts the need for hemorrhage control intervention-Results of an AAST multi-institutional study.
作者信息
Costantini Todd W, Coimbra Raul, Holcomb John B, Podbielski Jeanette M, Catalano Richard D, Blackburn Allie, Scalea Thomas M, Stein Deborah M, Williams Lashonda, Conflitti Joseph, Keeney Scott, Hoey Christy, Zhou Tianhua, Sperry Jason, Skiada Dimitra, Inaba Kenji, Williams Brian H, Minei Joseph P, Privette Alicia, Mackersie Robert C, Robinson Brenton R, Moore Forrest O
机构信息
From the Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery (T.W.C., R.C.), University of California San Diego Health Sciences, San Diego, California; University of Texas Health Sciences Center-Houston (J.B.H., J.M.P.), Houston, Texas; Loma Linda University Medical Center (R.D.C., A.B.), Loma Linda, California; R Adams Cowley Shock Trauma Center (T.M.S., D.M.S.), Baltimore, Maryland; East Texas Medical Center (L.W., J.C.), Tyler, Texas; St. Luke's University Health Network (S.K., C.H.), Bethlehem, Pennsylvania; University of Pittsburgh Medical Center (T.Z., J.S.), Pittsburgh, Pennsylvania; University of Southern California (D.S., K.I.), Los Angeles, California; University of Texas Southwestern Medical Center (B.H.W., J.P.M.), Dallas, Texas; San Francisco General Hospital and Trauma Center (A.P., R.C.M.), San Francisco, California; and Chandler Regional Medical Center (B.R.R., F.O.M), Chandler, Arizona.
出版信息
J Trauma Acute Care Surg. 2017 Jun;82(6):1030-1038. doi: 10.1097/TA.0000000000001465.
BACKGROUND
Early identification of patients with pelvic fractures at risk of severe bleeding requiring intervention is critical. We performed a multi-institutional study to test our hypothesis that pelvic fracture patterns predict the need for a pelvic hemorrhage control intervention.
METHODS
This prospective, observational, multicenter study enrolled patients with pelvic fracture due to blunt trauma. Inclusion criteria included shock on admission (systolic blood pressure <90 mm Hg or heart rate >120 beats/min and base deficit >5, and the ability to review pelvic imaging). Demographic data, open pelvic fracture, blood transfusion, pelvic hemorrhage control intervention (angioembolization, external fixator, pelvic packing, and/or REBOA [resuscitative balloon occlusion of the aorta]), and mortality were recorded. Pelvic fracture pattern was classified according to Young-Burgess in a blinded fashion. Predictors of pelvic hemorrhage control intervention and mortality were analyzed by univariate and multivariate regression analyses.
RESULTS
A total of 163 patients presenting in shock were enrolled from 11 Level I trauma centers. The most common pelvic fracture pattern was lateral compression I, followed by lateral compression I, and vertical shear. Of the 12 patients with an anterior-posterior compression III fracture, 10 (83%) required a pelvic hemorrhage control intervention. Factors associated with the need for pelvic fracture hemorrhage control intervention on univariate analysis included vertical shear pelvic fracture pattern, increasing age, and transfusion of blood products. Anterior-posterior compression III fracture patterns and open pelvic fracture predicted the need for pelvic hemorrhage control intervention on multivariate analysis. Overall in-hospital mortality for patients admitted in shock with pelvic fracture was 30% and did not differ based on pelvic fracture pattern on multivariate analysis.
CONCLUSION
Blunt trauma patients admitted in shock with anterior-posterior compression III fracture patterns or patients with open pelvic fracture are at greatest risk of bleeding requiring pelvic hemorrhage control intervention.
LEVEL OF EVIDENCE
Prognostic/epidemiologic study, level III.
背景
早期识别有严重出血风险且需要干预的骨盆骨折患者至关重要。我们进行了一项多机构研究，以检验我们的假设，即骨盆骨折类型可预测骨盆出血控制干预的必要性。
方法
这项前瞻性、观察性、多中心研究纳入了因钝性创伤导致骨盆骨折的患者。纳入标准包括入院时休克（收缩压<90 mmHg或心率>120次/分钟且碱缺失>5，以及能够复查骨盆影像学检查）。记录人口统计学数据、开放性骨盆骨折、输血情况、骨盆出血控制干预（血管栓塞、外固定器、骨盆填塞和/或主动脉球囊阻断复苏术[REBOA]）以及死亡率。骨盆骨折类型按照Young-Burgess分类法进行盲法分类。通过单因素和多因素回归分析来分析骨盆出血控制干预和死亡率的预测因素。
结果
从11个一级创伤中心共纳入了163例休克患者。最常见的骨盆骨折类型是侧方压缩I型，其次是侧方压缩II型和垂直剪切型。在12例前后压缩III型骨折患者中，10例（83%）需要进行骨盆出血控制干预。单因素分析中与骨盆骨折出血控制干预需求相关的因素包括垂直剪切型骨盆骨折类型、年龄增加以及血液制品输血。多因素分析中，前后压缩III型骨折类型和开放性骨盆骨折可预测骨盆出血控制干预的需求。总体而言，因骨盆骨折休克入院患者的院内死亡率为30%，多因素分析中基于骨盆骨折类型并无差异。
结论
因钝性创伤休克入院且有前后压缩III型骨折类型的患者或开放性骨盆骨折患者发生需要骨盆出血控制干预的出血风险最高。
证据级别
预后/流行病学研究，III级。
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