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Anaesth Crit Care Pain Med. 2019 Apr;38(2):199-207. doi: 10.1016/j.accpm.2018.12.003. Epub 2018 Dec 21.

Early management of severe pelvic injury (first 24 hours).

Author information

1
Hospices Civils de Lyon, centre hospitalier Lyon Sud, service d'anesthésie-réanimation, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France. Electronic address: pascal.incagnoli@chu-lyon.fr.
2
Direction centrale du service de santé des armées, 60, boulevard du Général-Marcel-Valin, 75509 Paris, France.
3
Ecole du Val de Grâce, hôpital d'instruction des armées Percy, 1, rue du Lieutenant-Raoul-Batany, 92190 Clamart, France.
4
CHU de Nîmes, service de radiologie et d'imagerie médicale, place du Pr-Robert-Debré, 30029 Nimes, France.
5
Assistance publique des Hôpitaux de Marseille, SAMU 13, pôle RUSH, CHU de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France.
6
CHU de Nîmes, division anesthésie-réanimation douleur urgences, 30029 Nimes, France.
7
Grenoble Alpes Trauma Centre, pôle anesthésie-réanimation, boulevard de la Chantourne, 38700 La Tronche, France.
8
CHU de Toulouse, service d'anesthésie-réanimation, hôpital Purpan, 1, place du Dr Balzac, 31300 Toulouse, France.
9
CHU de Caen, pôle réanimations-anesthésie-samu, avenue Côtes de Nacre, 14033 Caen, France.
10
Centre hospitalier du Mans, service des urgences, 194, avenue Rubillard, 72037 Le Mans, France.
11
CHU de la Réunion, hôpital Bellepierre, SAMU 974, 97405 Saint Denis, France.
12
Hospices Civils de Lyon, centre hospitalier Lyon Sud, service d'anesthésie-réanimation, faculté de médecine Lyon Est, Université de Lyon 1 Claude-Bernard, 165, chemin du Grand Revoyet, 69495 Pierre Bénite, France.
13
Hôpital d'instruction des Armées du Val de Grace, service de chirurgie urologique, 75005 Paris, France.
14
CHRU de Lille, service d'accueil des urgences vitales chirurgicales, 2, avenue Oscar-Lambret 59037 Lille, France.
15
CHRU de Lille, service de chirurgie de l'urgence, 2, avenue Oscar-Lambret 59037 Lille, France.
16
Hôpital d'instruction des armées Desgenettes, service de chirurgie orthopédique et traumatologique, 108, boulevard Pinel, 69003 Lyon, France.
17
Assistance publique des Hôpitaux Paris, CHU de Necker-Enfants Malades, SAMU de Paris et service d'anesthésie-réanimation, 149, rue de Sèvres, 75330 Paris, France.
18
Assistance publique des Hôpitaux Paris, hôpital Beaujon, servie d'anesthésie-réanimation, réanimation chirurgicale, hôpitaux universitaires Paris Nord Val de Seine, 92110 Clichy, France.
19
Assistance publique des Hôpitaux Paris, CHU de Bicêtre, service d'anesthésie-réanimation, reanimation chirurgicale, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
20
CHRU de Lille, réanimation chirurgicale, pôle d'anesthésie-réanimation, 2 avenue Oscar-Lambret 59037 Lille, France.

Abstract

OBJECTIVE:

Pelvic fractures represent 5% of all traumatic fractures and 30% are isolated pelvic fractures. Pelvic fractures are found in 10 to 20% of severe trauma patients and their presence is highly correlated to increasing trauma severity scores. The high mortality of pelvic trauma, about 8 to 15%, is related to actively bleeding pelvic injuries and/or associated injuries to the head, abdomen or chest. Regardless of the severity of pelvic trauma, diagnosis and treatment must proceed according to a strategy that does not delay the management of the most severely injured patients. To date, in France, there are no guidelines issued by healthcare authorities or professional societies that address this subject.

DESIGN:

A consensus committee of 22 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et de Réanimation; SFAR) and the French Society of Emergency Medicine (Société Française de Médecine d'Urgence; SFMU) in collaboration with the French Society of Radiology (Société Française de Radiologie; SFR), French Defence Health Service (Service de Santé des Armées; SSA), French Society of Urology (Association Française d'Urologie; AFU), the French Society of Orthopaedic and Trauma Surgery (Société Française de Chirurgie Orthopédique et Traumatologique; SOCFCOT), and the French Society of Digestive Surgery (Société Française de Chirurgie digestive; SFCD) was convened. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently from any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised.

METHODS:

Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the recommendations were then conducted according to the GRADE® methodology.

RESULTS:

The SFAR Guideline panel provided 22 statements on prehospital and hospital management of the unstable patient with pelvic fracture. After three rounds of discussion and various amendments, a strong agreement was reached for 100% of recommendations. Of these recommendations, 11 have a high level of evidence (Grade 1 ± ), 11 have a low level of evidence (Grade 2 ± ).

CONCLUSIONS:

Substantial agreement exists among experts regarding many strong recommendations for management of the unstable patient with pelvic fracture.

KEYWORDS:

Arterial embolization; Pelvic trauma; Prehospital setting; Severity criteria; Trauma network

PMID:
30579941
DOI:
10.1016/j.accpm.2018.12.003
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