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Objectives: PRIs occur in 25% of severely injured patients. Concomitant vascular injuries (VIs) are rare. The goal is to stop bleeding. It involves diagnostics, surgical, bleeding management. Aim of the study is to analyze clinical strategies and develop tools to detect VIs. It is hypothesized that simple CT-methods could be a predictive tool to estimate the volume of pelvis related bleedings and to determine who could benefit from early interventional, resuscitative measures.

Methods: In this retrospective study patient data was obtained from the Database of 3 Trauma Centers in Germany. Patients admitted to the ER with confirmed Tile B/C PRI. Analysis of all injured identified 229 cases. In data analysis patient’s charts, radiographical diagnostics, mechanism and the pattern of injury were identified as well as the specific pelvis related vascular bleeding source. Cases with VIs were analyzed for age, sex, trauma, hospital stay, method of treatment, death, preclinical fluid management, clinical strategies. Statistical analysis was performed descriptively and through inference statistical calculation using univariate analysis, Mann-Whitney-U-Test, Kruskal-Wallis-Test. T-test was used to identify significance (p ≤ 0.05). In a second analysis formula by Kothari was used to estimate the size of the hematoma in CT-scans.

Results: Between Jan. 2021 – Dec. 2022, 229 pelvic trauma patients (ISS16, AISPelvis ≥3) were admitted to the TRU. Patient age was 42 years ±20; 62,8% m, 37,1% f., 60 C-type-injuries. Mortality was 12,7%. 98% suffered concomitant injuries. Pelvis related bleeding was observed in n=56. Median planimetric bleeding vol. was 379,6 ml. Relevant bleedings (vol. >100 ml) occurred in n=15. Significant differences in bleeding volume were seen in comparison of C1- and C3-fractures. In 53,5% measurement of Kothari determine the pelvis related hematoma. Surgical procedures were carried out more in patients with pelvis related VIs. Open repair of VI was performed in 7,4%, endovascular procedures in 3,1%. Bleeding control was achieved through packing in 3,9%. In 69,8% the pelvis was stabilized with external fixator. Hospital stay was approx. 17,1 d. In prehospital phase, vasopressors were administered in 48%, tranexamic acid in 4,8%. 35,8% received preclinical a pelvic binder. In 25,3% the position was correct. 91 patients received initial blood transfusions.

Conclusion: Geometric models can determine exact approximation to the volume of intraplevic hematomas. Due to timesaving quantification of volume a structured approach so called clear-the-pelvis algorithm can help to identify the pelvis as source of bleeding in severely injured patients and serve as a decision-making aid in trauma management.