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Wohlrath, B.; Trentzsch, H.; Hoffmann, R.; Kremer, M.; Schmidt-Horlohè, K.; Schweigkofler, U. (2016): Präklinische und klinische Versorgung der instabilen Beckenverletzung. Ergebnisse einer Online-Umfrage. In: Unfallchirurg, Vol. 119, No. 9: pp. 755-762
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Abstract

Instable pelvic injuries are often associated with a high blood loss, which can effectively be curtailed by rapid external stabilization of the pelvis. The S3 guidelines on the treatment of multiple trauma and the severely injured recommend an initial stability testing in cases of an instable pelvis and hemodynamic instability even though the sensitivity is very low, with subsequent external stabilization. Radiological diagnostic procedures are also becoming more important for early diagnostics. An online survey of the current management of instable pelvic injuries was carried out with 266 participants via the e-mail distribution list of the German Society of Trauma Surgery (DGU). Most answers in the survey were received from very experienced senior and chief physicians at level 1 trauma centers. The vast majority of the participants recommended carrying out mechanical stabilization testing and most wanted to do the testing themselves independent of any previous findings. Most participants would only carry out a pelvic stabilization if they themselves had recognized instability during the stability testing and many of them even in cases of hemodynamic instability alone, although several studies have reported a very low sensitivity of 26-44% for stability testing. The preferred procedure for emergency stabilization in the emergency room was the pelvic sling, which in contrast to invasive tools was often implemented before radiological imaging was completed. In preclinical treatment the vacuum mattress was used more often for stabilization than the pelvic sling. In radiological examinations a whole body computed tomography (CT) scan was mostly used, sometimes combined with an anteroposterior pelvic x-ray. In cases of persisting hemorrhage in spite of external stabilization, most participants preferred a pelvic tamponade but angioembolization was also highly rated. Because many of the participants relied on their own findings from stability testing for a decision on external emergency stabilization despite the very low sensitivity, in cases of false negative testing there is a risk of insufficient treatment resulting in life-threatening hemorrhage. From our viewpoint, it therefore makes sense to treat patients with a suspicion of instable pelvic fractures based on the trauma mechanism and clinical examination (without mechanical stability testing) with non-invasive external pelvic stabilization as early as possible.