Laparotomy or Angiography First for Pelvic Fracture with Intraperitoneal Hemorrhage?

Up to two thirds of patients with severe pelvic fracture also have intraperitoneal hemorrhage, and debate continues about which area of hemorrhage to stabilize first. In an observational cohort study, researchers used the Japan Trauma Data Bank to determine patient outcomes based on whether laparotomy or pelvic angiography was performed first.

Of 317 trauma patients with pelvic fracture and positive results on Focused Assessment with Sonography for Trauma (FAST) during a 6-year period, 123 underwent laparotomy as the first intervention and 194 underwent angiography. The laparotomy-first group had a higher mean Injury Severity Score and lower mean systolic blood pressure. However, half the patients who were hypotensive (systolic blood pressur…