Early management of severe pelvic injury (first 24 hours)

Autor: 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
Přispěvatelé: 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
Jazyk: angličtina
Rok vydání: 2019
Předmět:
medicine.medical_specialty
Critical Care
Population
Critical Care and Intensive Care Medicine
Pelvis
Fractures
Bone
03 medical and health sciences
BIOMECANIQUE
[SPI]Engineering Sciences [physics]
0302 clinical medicine
PELVIC TRAUMA
PREHOSPITAL SETTING
Health care
Humans
Medicine
Anesthesia
TRAUMA NETWORK
education
030222 orthopedics
education.field_of_study
Trauma Severity Indices
business.industry
General surgery
ARTERIAL EMBOLIZATION
SEVERITY CRITERIA
[SPI.MECA.BIOM]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Biomechanics [physics.med-ph]
030208 emergency & critical care medicine
General Medicine
Guideline
Evidence-based medicine
medicine.disease
3. Good health
Anesthesiology and Pain Medicine
medicine.anatomical_structure
Pelvic fracture
Wounds and Injuries
Abdomen
Professional association
business
Trauma surgery
Zdroj: 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⟩
ISSN: 2352-5568
Popis: 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.
Databáze: OpenAIRE
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