Pelvic Fracture Bleeding — Angiography or Preperitoneal Packing

Objective: To determine if preperitoneal pelvic packing (PPP) versus pelvic angiography with or without embolization (PAE) is associated with better survival in patients with hemorrhage from pelvic ring fractures (PRFs). Design: Prospective, multicenter observational study. Participants: Patients with radiographic documentation of a PRF from blunt trauma and a systolic blood pressure (SBP) of ≤90 mm Hg within the first hour of arrival. Methods: This trial was run through the American Association for the Surgery of Trauma multicenter trials committee during a 2-year period at 47 sites. The sample size needed to detect a 10% mortality difference was calculated at 350 patients per group; however, low recruitment in the PPP group led to premature closure of the study. Patients were included if they were hypotensive on admission with a PRF. The primary outcome was 3- and 6-hour mortality. Multivariate regression analysis controlling for demographics, injury severity, admission physiology, more...