• Min A Lee, Byungchul Yu, Jungnam Lee, Jae Jeong Park, Gil Jae Lee, Kang Kook Choi, Youngeun Park, Jihun Gwak, and Ahram Han.
• Department of Trauma Surgery, Gachon University Gil Medical Center, 21, Namdong-daero, 774 Beon-gil, Namdong-gu, Incheon, 21565, South Korea.
• Eur J Trauma Emerg Surg. 2019 Apr 1; 45 (2): 273-279.

PurposeThe aim of this study was to determine whether the outcomes of patients with hemodynamically unstable pelvic bone fractures changed after the introduction of a protocol including extraperitoneal pelvic packing (EPP) and the establishment of a trauma center.MethodsWe analyzed data of adult patients (≥ 18 years old) with hemodynamically unstable pelvic bone fractures who visited a single trauma center from February 2009 to October 2016. In July 2014, a new protocol for pelvic fractures was implemented, and a trauma center was established. Therefore, patient outcomes were compared by period (period I: pre-protocol vs. period II: post-protocol).ResultsSeventy-nine patients with hemodynamically unstable pelvic bone fractures were recruited. The time to angiographic embolization after arrival at the emergency room decreased significantly in period II when compared to period I (182.9 vs. 268.9 min, respectively, p < 0.001). The time required to intervention, including EPP, also decreased, from 268.9 ± 132.4 min in period I to 141.9 ± 79.9 min in period II (p < 0.001). The overall mortality rate decreased from 47.2% in period I to 23.3% in period II (p = 0.033), and mortality related to hemorrhagic shock in particular, was significantly lowered, from 27.8% in period I to 4.7% in period II (p = 0.009).ConclusionsThe establishment of a trauma center and the implementation of a new protocol that included EPP were effective in the treatment of patients with hemodynamically unstable pelvic fractures.

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