{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T01:34:16Z","timestamp":1787621656184,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T00:00:00Z","timestamp":1673913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T00:00:00Z","timestamp":1673913600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T00:00:00Z","timestamp":1673913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pelvic fracture\u2010associated bleeding can be difficult to control with historically high mortality rates. The impact of resuscitation advancements for trauma patients with unstable pelvic ring injuries is unknown. We hypothesized that the time elapsed since introduction of our protocol would be associated with decreased blood transfusion requirements.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A level 1 trauma center's prospective pelvic fracture database was reviewed from 01\/01\/2009\u201331\/12\/2018. All patients with unstable pelvic ring injuries initially presenting to our institution were included. Adjusted regression analysis was performed on the overall cohort and separately for patients in traumatic shock (TS). The primary outcome was 24 h packed red blood cell (PRBC) requirements. Secondary outcomes were 24 h plasma, cryoprecipitate, platelet and intravenous fluid (IVF) requirements, length of stay and mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with mechanically unstable pelvic ring injuries (<jats:italic>n<\/jats:italic>\u2009=\u2009144, median [Q<jats:sub>1<\/jats:sub>\u2013Q<jats:sub>3<\/jats:sub>] age 44 [28\u201355] years, 74% male) received a median (Q<jats:sub>1<\/jats:sub>\u2013Q<jats:sub>3<\/jats:sub>) of 0 (0\u20134) units PRBC within 24 h, with TS patients (<jats:italic>n<\/jats:italic>\u2009=\u200947, 42 [28\u201360] years, 74% male) receiving 6 (4\u20139) units PRBC. There was no decrease in 24 h PRBC requirements for the overall cohort (years; IRR\u2009=\u20090.91, 95% CI 0.83\u20131.01; <jats:italic>p<\/jats:italic>\u2009=\u20090.07). TS patients had decreases in 24 h PRBC (years; IRR\u2009=\u20090.90, 95%CI 0.84\u20130.96; <jats:italic>p<\/jats:italic>\u2009=\u20090.002), plasma (IRR\u2009=\u20090.92, 95%CI 0.85\u20130.99; <jats:italic>p<\/jats:italic>\u2009=\u20090.019), cryoprecipitate (IRR\u2009=\u20090.88, 95%CI 0.81\u20130.95; <jats:italic>p<\/jats:italic>\u2009=\u20090.001) and IVF (IRR\u2009=\u20090.94, 95%CI 0.90\u20130.98; <jats:italic>p<\/jats:italic>\u2009=\u20090.004). There were 5 deaths (5\/144, 3.5%) with no deaths due to acute hemorrhage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Over this 10\u2010year period, there was no hemorrhage\u2010related mortality among patients presenting with pelvic fractures. Crystalloid and transfusion requirements decreased for patients presenting with traumatic shock.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-023-06897-7","type":"journal-article","created":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T14:03:12Z","timestamp":1673964192000},"page":"1136-1143","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Major Pelvic Ring Injuries: Fewer Transfusions Without Deaths from Bleeding During the Last Decade"],"prefix":"10.1002","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7366-0470","authenticated-orcid":false,"given":"Giles L.","family":"Devaney","sequence":"first","affiliation":[{"name":"Department of Traumatology John Hunter Hospital Lookout Rd 2305 Newcastle NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1404-9983","authenticated-orcid":false,"given":"Seth M.","family":"Tarrant","sequence":"additional","affiliation":[{"name":"Department of Traumatology John Hunter Hospital Lookout Rd 2305 Newcastle NSW Australia"},{"name":"School of Medicine and Public Health University of Newcastle 2308 Callaghan NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9640-1647","authenticated-orcid":false,"given":"Natasha","family":"Weaver","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health University of Newcastle 2308 Callaghan NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1936-9003","authenticated-orcid":false,"given":"Kate L.","family":"King","sequence":"additional","affiliation":[{"name":"Department of Traumatology John Hunter Hospital Lookout Rd 2305 Newcastle NSW Australia"},{"name":"School of Medicine and Public Health University of Newcastle 2308 Callaghan NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0277-4822","authenticated-orcid":false,"given":"Zsolt J.","family":"Balogh","sequence":"additional","affiliation":[{"name":"Department of Traumatology John Hunter Hospital Lookout Rd 2305 Newcastle NSW Australia"},{"name":"School of Medicine and Public Health University of Newcastle 2308 Callaghan NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,17]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373\u2010198611000\u201000005"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.96B8.33383"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054\u2010019\u20102347\u20103"},{"key":"e_1_2_9_5_1","unstructured":"National Blood Authority(2011)Module 1: Critical Bleeding\/Massive Transfusion. 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