Table 1 The guideline principles with a high level of evidence [25, 26, 27, 37]

 1

CT is recommended for the evaluation of haemodynamically stable patients with equivocal findings on physical examination, associated neurological injury, or multiple extra-abdominal injuries. Under these circumstances, patients with a negative CT should be admitted for observation. In haemodynamically stable patients the CT is a complementary diagnostic modality

 2

Exploratory laparotomy is indicated in haemodynamically unstable patients with a positive FAST. In haemodynamically stable patients with a positive FAST, follow-up CT allows for a non-operative management of select injuries [9]

 3

A negative FAST should prompt follow-up CT for patients at high risk for intra-abdominal injuries (e.g., multiple orthopaedic injuries, severe chest wall trauma, and neurological impairment)

 4

Patients with a major pelvic fracture with signs of on going bleeding after non-pelvic sources of blood loss have been ruled out should be considered for pelvic angiography and possible embolization

 5

Patients with evidence of unstable fractures of the pelvis associated with hypotension should be considered for some form of external pelvic stabilization

 6

Patients with evidence of unstable pelvic fractures who warrant laparotomy should receive external pelvic stabilization prior to laparotomy incision

 7

Patients with major pelvic fracture who are found to have bleeding in the pelvis, which cannot be adequately controlled at laparotomy, should be considered for pelvic angiography and possible embolization

 8

Patients with evidence of arterial extravasation of intravenous contrast in the pelvis by computed tomography should be considered for pelvic angiography and possible embolization

 9

Patients with hypotension and gross blood in the abdomen or evidence of intestinal perforation warrant emergent laparotomy

 10

Urgent laparotomy is warranted for patients who demonstrate signs of continued intra-abdominal bleeding after adequate resuscitation, or evidence of intestinal perforation