Abstract
Study objective
To determine longitudinal trends in mortality, and the contribution of specific injury
characteristics and treatment modalities to the risk of a fatal outcome after severe
and complex pelvic trauma.
Methods
We studied 5048 patients with pelvic ring fractures enrolled in the German Pelvic
Trauma Registry Initiative between 1991 and 1993, 1998 and 2000, and 2004 and 2006.
Complete datasets were available for 5014 cases, including 508 complex injuries, defined
as unstable fractures with severe peri-pelvic soft tissue and organ laceration. Multivariable
mixed-effects logistic regression analysis was employed to evaluate the impact of
demographic, injury- and treatment-associated variables on all-cause in-hospital mortality.
Results
All-cause in-hospital mortality declined from 8% (39/466) in 1991 to 5% (33/638) in
2006. Controlling for age, Injury Severity Score, pelvic vessel injury, the need for
emergency laparotomy, and application of a pelvic clamp, the odds ratio (OR) per annum
was 0.94 (95% confidence interval [CI] 0.91–0.96). However, the risk of death did
not decrease significantly in patients with complex injuries (OR 0.98, 95% CI 0.93–1.03).
Raw mortality associated with this type of injury was 18% (95% CI 9–32%) in 2006.
Conclusion
In contrast to an overall decline in trauma mortality, complex pelvic ring injuries
remain associated with a significant risk of death. Awareness of this potentially
life-threatening condition should be increased amongst trauma care professionals,
and early management protocols need to be implemented to improve the survival prognosis.
Keywords
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Article info
Publication history
Accepted:
March 25,
2011
Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
