Eastern Association for the Surgery of Trauma Practice Management Guidelines for Hemorrhage in Pelvic Fracture-Update and Systematic Review
Eastern Association for the Surgery of Trauma Practice Management Guidelines for Hemorrhage in Pelvic Fracture-Update and Systematic Review
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DOI：
10.1097/ta.0b013e31823dca9a
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发表时间：
2011-12-01
影响因子：
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通讯作者：
Wynne, Julie L.
中科院分区：
文献类型：
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作者：
Cullinane, Daniel C.;Schiller, Henry J.;Wynne, Julie L.
背景：骨盆骨折出血在钝性创伤患者中很常见。2001年，东部创伤外科协会（EAST）发布了骨盆创伤出血处理的实践管理指南。从那时起，出现了新的实践模式，并且对旧技术有了更丰富的经验。EAST实践指南委员会决定用反映当前实践的更新指南和系统综述来取代2001年的指南。
方法：在2001年EAST指南中先前的系统文献综述基础上，进行了一项系统文献综述，纳入了1999年至2010年的参考文献。包括前瞻性和回顾性研究，排除综述和病例报告。在确定的1432篇文章中，有50篇符合标准被选中。9名创伤外科医生、1名介入放射科医生和1名骨科医生对这些文章进行了审阅。使用EAST入门指南对证据进行分级。
结果：针对骨盆骨折出血提出了6个问题：（1）哪些血流动力学不稳定的骨盆骨折患者需要早期外部机械稳定？（2）哪些患者需要紧急血管造影？（3）排除骨盆外出血的最佳检查是什么？（4）是否有可预测出血的影像学发现？（5）无创临时性外固定装置的作用是什么？（6）哪些患者需要腹膜前填塞？
结论：骨盆骨折导致的出血仍然是创伤患者发病和死亡的主要原因。针对问题1至4提出了强烈建议。需要进一步研究来回答问题5和6。
Background: Hemorrhage from pelvic fracture is common in victims of blunt traumatic injury. In 2001, the Eastern Association for the Surgery of Trauma (EAST) published practice management guidelines for the management of hemorrhage in pelvic trauma. Since that time there have been new practice patterns and larger experiences with older techniques. The Practice Guidelines Committee of EAST decided to replace the 2001 guidelines with an updated guideline and systematic review reflecting current practice.Methods: Building on the previous systematic literature review in the 2001 EAST guidelines, a systematic literature review was performed to include references from 1999 to 2010. Prospective and retrospective studies were included. Reviews and case reports were excluded. Of the 1,432 articles identified, 50 were selected as meeting criteria. Nine Trauma Surgeons, an Interventional Radiologist, and an Orthopedic Surgeon reviewed the articles. The EAST primer was used to grade the evidence.Results: Six questions regarding hemorrhage from pelvic fracture were addressed: (1) Which patients with hemodynamically unstable pelvic fractures warrant early external mechanical stabilization? (2) Which patients require emergent angiography? (3) What is the best test to exclude extrapelvic bleeding? (4) Are there radiologic findings which predict hemorrhage? (5) What is the role of noninvasive temporary external fixation devices? and (6) Which patients warrant preperitoneal packing?Conclusions: Hemorrhage due to pelvic fracture remains a major cause of morbidity and mortality in the trauma patient. Strong recommendations were made regarding questions 1 to 4. Further study is needed to answer questions 5 and 6.