XXXX associated with major @entity174 : a multispecialty challenge.

@entity1 @entity295 @entity174 @entity548 @entity853 @entity38176 @entity530
Definitive treatment of life-threatening @entity548 associated with blunt @entity174 remains controversial. To elucidate this issue, we reviewed 538 consecutive @entity1 admitted with acute @entity174 during a 5-year period. Injury mechanism was motor vehicular in 214 (40%), falls in 152 (28%), auto-pedestrian in 92 (17%), motorcycle in 46 (9%), crush in 26 (5%), and assault or skiing in eight (1%). Ninety-two (17%) of these @entity1 required greater than 6 units of blood transfusion during the first postinjury day, and are the primary focus of this report. Twenty-five @entity1 (28%) had unilateral anterior (Group I, n = 20) or posterior (Group II, n = 5) @entity174 . The remaining 67 @entity1 (72%) had anterior and posterior element involvement on the same side (Group II, n = 38), bilaterally (Group IV, n = 14), or open perineal wounds (Group V, n = 15). The @entity38176 was applied in 47 @entity1 (51%), and controlled @entity548 in 12 (71%) of the 17 in whom it was used alone to tamponade @entity548 . Peritoneal lavage was performed in 73 @entity1 (79%). Initial aspirate yielded gross blood in 32 @entity1 ; 27 (84%) of these required urgent laparotomy. @entity853 was applied in 19 @entity1 ; @entity548 was controlled in 18 (95%). Pelvic angiography identified active @entity548 in three @entity1 and selective embolization was successful in two. Sixty-eight (74%) of the high-risk @entity1 survived. Thirteen (54%) of the 24 deaths were attributable to the @entity530 , ten were due to recalcitrant @entity548 , and three to delayed @entity295 .(ABSTRACT TRUNCATED AT 250 WORDS)
