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Early management of severe pelvic injury (first 24 hours)

Early management of severe pelvic injury (first 24 hours)

Authors :
Pascal Incagnoli
Fréderic Rongieras
Tobias Gauss
Clément Buléon
Delphine Garrigue
Jean-Luc Hanouz
Jacques Choukroun
Eric Kipnis
Isabelle Plenier
Anatole Harrois
François Régis Desfemmes
Jean Stephane David
Xavier Combes
Pierre Bouzat
Elodie Brunel
Sylvain Ausset
Xavier Bobbia
Benoît Vivien
Jacques Bessereau
Julien Brun
Jean Paul Beregi
Alain Puidupin
Service d'anesthésie-réanimation
Hospices Civils de Lyon, centre hospitalier Lyon Sud
Direction centrale du service de santé des armées
École du Val de Grâce (EVDG)
Service de Santé des Armées
Service de radiologie et d'imagerie médicale
Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)
Assistance publique des Hôpitaux de Marseille
SAMU 13, pôle RUSH, CHU de la Timone
Division anesthésie-réanimation douleur urgences
Pôle anesthésie-réanimation
Grenoble Alpes Trauma Centre
Service d'anesthésie-réanimation, hôpital Purpan
CHU Toulouse [Toulouse]
Service Réanimation médico-chirurgicale [CH Le Mans]
Centre Hospitalier Le Mans (CH Le Mans)
Hôpital Bellepierre, SAMU 974
Centre Hospitalier Universitaire de La Réunion (CHU La Réunion)
Service de chirurgie urologique
Hôpital d'instruction des Armées du Val de Grace
Service d'accueil des urgences vitales chirurgicales
CHRU de Lille
Service de chirurgie de l'urgence
Laboratoire de Biomécanique et Mécanique des Chocs (LBMC UMR T9406)
Université Claude Bernard Lyon 1 (UCBL)
Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR)
CHU Necker - Enfants Malades [AP-HP]
Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Assistance publique des Hôpitaux Paris, hôpital Beaujon, servie d'anesthésie-réanimation, réanimation chirurgicale
Hôpitaux Universitaires Paris Nord Val de Seine
Service d'anesthésie-réanimation, reanimation chirurgicale
Assistance publique des Hôpitaux Paris, CHU de Bicêtre
Pôle d'anesthésie-réanimation
CHRU de Lille, réanimation chirurgicale
Source :
Anaesthesia Critical Care & Pain Medicine, Anaesthesia Critical Care & Pain Medicine, Elsevier Masson, 2019, 38 (2), pp. 199-207. ⟨10.1016/j.accpm.2018.12.003⟩
Publication Year :
2019
Publisher :
HAL CCSD, 2019.

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 (Societe Francaise d’Anesthesie et de Reanimation; SFAR) and the French Society of Emergency Medicine (Societe Francaise de Medecine d’Urgence; SFMU) in collaboration with the French Society of Radiology (Societe Francaise de Radiologie; SFR), French Defence Health Service (Service de Sante des Armees; SSA), French Society of Urology (Association Francaise d’Urologie; AFU), the French Society of Orthopaedic and Trauma Surgery (Societe Francaise de Chirurgie Orthopedique et Traumatologique; SOCFCOT), and the French Society of Digestive Surgery (Societe Francaise 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.

Details

Language :
English
ISSN :
23525568
Database :
OpenAIRE
Journal :
Anaesthesia Critical Care & Pain Medicine, Anaesthesia Critical Care & Pain Medicine, Elsevier Masson, 2019, 38 (2), pp. 199-207. ⟨10.1016/j.accpm.2018.12.003⟩
Accession number :
edsair.doi.dedup.....7426099361d5b317536c38f1cab4fe6a
Full Text :
https://doi.org/10.1016/j.accpm.2018.12.003⟩