Acute Management of Hemodynamically Unstable Pelvic Trauma Patients: Time for a Change? Multicenter Review of Recent Practice Diederik Verbeek Æ Michael Sugrue Æ Zsolt Balogh Æ Danny Cass Æ Ian Civil Æ Ian Harris Æ Thomas Kossmann Æ Steve Leibman Æ Valerie Malka Æ Anthony Pohl Æ Sudhakar Rao Æ Martin Richardson Æ Michael Schuetz Æ Caesar Ursic Æ Vanessa Wills Published online: 3 May 2008 Ó Socie ´te ´ Internationale de Chirurgie 2008 Abstract Background Hemorrhage-related mortality (HRM) asso- ciated with pelvic fractures continues to challenge trauma care. This study describes the management and outcome of hemodynamically unstable patients with a pelvic fracture, with emphasis on primary intervention for hemorrhage control and HRM. Methods Blunt trauma patients [Injury Severity Score (ISS) C16] with a major pelvic fracture (Abbreviated Injury Score, pelvis C3) and hemodynamic instability [admission systolic blood pressure (SBP) B90 mmHg or receiving C6 units of packed red blood cells (PRBCs)/24 hours) were included into a 48-month (ending in December 2003) multicenter retrospective study of 11 major trauma centers. Data are presented as the mean ± SD. Results A total of 217 patients (mean age 41 ± 19 years, 71% male, ISS 42 ± 16) were studied. The admission SBP was 96 ± 37 mmHg and the Glascow Coma Scale (GCS) 11 ± 5. Patients received 4 ± 2 liters of fluids including 4 ± 4 units of PRBCs in the emergency room (ER). In total, 69 (32%) patients died, among whom the HRM was 19%; 29% of the deaths were due to pelvic bleeding. Altogether, 120 of the 217 (55%) patients underwent focused abdominal sonography for trauma (FAST) or D. Verbeek (&) Trauma Department, Academic Medical Center, PO Box 22660, Amsterdam 1100 DD, The Netherlands e-mail: diederikverbeek@hotmail.com M. Sugrue Trauma Department, Liverpool Hospital, Sydney, NSW, Australia Z. Balogh Á V. Wills Trauma Department, John Hunter Hospital, Newcastle, NSW, Australia D. Cass Institute of Trauma and Injury Management (ITIM), Sydney, NSW, Australia I. Civil Trauma Department, Auckland Hospital, Grafton, New Zealand I. Harris Department of Orthopaedics, Liverpool Hospital, Sydney, NSW, Australia T. Kossmann Trauma Department, Alfred Hospital, Prahran, VIC, Australia S. Leibman Trauma Department, Royal North Shore Hospital, Sydney, NSW, Australia V. Malka Trauma Department, Westmead Hospital, Westmead, NSW, Australia A. Pohl Orthopaedics and Trauma Departments, Royal Adelaide Hospital, Adelaide, SA, Australia S. Rao Trauma Department, Royal Perth Hospital, Perth, WA, Australia M. Richardson Department of Orthopaedics, Royal Melbourne Hospital, Parkville, VIC, Australia M. Schuetz Trauma Department, Princess Alexandra Hospital, Brisbane, QLD, Australia C. Ursic Trauma Department, St. George Hospital, Sydney, NSW, Australia 123 World J Surg (2008) 32:1874–1882 DOI 10.1007/s00268-008-9591-z