Management Guideline in Haemodynamically Unstable Patients with Pelvic Fractures: Outcomes and Challenges

Clinical practice guidelines for haemodynamically unstable patients with pelvic fractures were initiated in February 2005 at our level 1 trauma centre. The purpose of the present study was to evaluate guideline adherence and outcome of guideline performance. In a retrospective clinical study all patients admitted with a pelvic fracture from August 2003 to March 2007 were identified from a prospective trauma registry database. Medical records of all patients were reviewed. Patients with pelvic fractures associated with haemodynamic instability were included. Patients were divided into two groups: preguideline and postguideline. The two groups were compared. Main outcome measurements were 24 h fluid requirement, total blood transfusion, length of stay in ICU and hospital, and mortality rate. Of the 210 patients with pelvic fractures, 32 patients met the inclusion criteria. Preguideline group consisted of 13 and postguideline group 19 patients. Non-invasive pelvic stabilization was applied significantly more postguideline (92.3% vs 33.3%, P= 0.004). Focused abdominal sonography for trauma and pelvic angiography/embolization have been used significantly more in the postguideline group (5 vs 14, P= 0.046 and 0 vs 6, P= 0.025, respectively). There was no significant difference in 24 h fluid requirement, total blood transfusion, length of stay in ICU and hospital, and mortality rate between the two groups. The introduction of guidelines has influenced the approach to haemodynamically unstable patients with pelvic fractures. Multiple factors can potentially influence the strict adherence to the guideline. Care provided can still be improved by addressing the challenges in guideline performance.