Abstract
Introduction
Traumatic disruption of the pelvic ring is uncommon but is associated with a high
risk of mortality. These injuries are predominantly due to high energy blunt trauma
such as a fall from height, road or workplace trauma, and severe associated injuries
are prevalent, increasing the complexity of managing this patient group. The aim of
this population-based study was to investigate predictors of mortality following severe
pelvic ring fractures managed in an inclusive, regionalised trauma system.
Methods
Cases aged ≥ 15 years from 1st July 2001 to 30th June 2008 were extracted from the population-based
statewide Victorian State Trauma Registry for analysis. Patient demographic, prehospital
and admission characteristics were considered as potential predictors of mortality.
Multivariate logistic regression was used to identify predictors of mortality with
adjusted odds ratios (AOR) and 95% confidence intervals (CI) calculated.
Results
There were 348 cases over the 8-year period. The mortality rate was 19%. Patients
aged ≥ 65 years were at higher odds of mortality (AOR 7.6, 95% CI: 2.8, 20.4) than patients
aged 15–34 years. Patients hypotensive at the scene (AOR 5.5, 95% CI: 2.3, 13.2),
and on arrival at the definitive hospital of care (AOR 3.7, 955 CI: 1.7, 8.0), were
more likely to die than patients without hypotension. The presence of a severe chest
injury was associated with an increased odds of mortality (AOR 2.8, 95% CI: 1.3, 6.1),
whilst patients injured in intentional events were also more likely to die than patients
involved in unintentional events (AOR 4.9, 95% CI: 1.6, 15.6). There was no association
between the hospital of definitive management and mortality after adjustment for other
variables, despite differences in the protocols for managing these patients at the
major trauma services (Level 1 trauma centres).
Conclusions
The findings highlight the importance of effective control of haemodynamic instability
for reducing the risk of mortality. As most patients survive these injuries, further
research should focus on long term morbidity and the impact of different treatment
approaches.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Assessment of volume of hemorrhage and outcome from pelvic fracture.Arch Surg. 2003; 138: 504-509
- Emergent pelvic fixation in patients with exsanguinating pelvic fractures.J Am Coll Surg. 2007; 204: 935-942
- Contemporary management of pelvic fractures.Am J Surg. 2006; 192: 211-223
- Update on the roles of angiography and embolisation in pelvic fracture.Injury. 2008; 39: 1290-1294
- Major pelvic fractures – identification of patients at high risk.J Bone Joint Surg Br. 2005; 87-B: 530-533
- The effect of pelvic fracture on mortality after trauma: an analysis of 63,000 trauma patients.J Bone Joint Surg Am. 2009; 91: 2803-2810
- Associated injuries and not fracture instability predict mortality in pelvic fractures: a prospective study of 100 patients.J Trauma. 2007; 62: 687-691
- Review of the pathophysiology and acute management of haemorrhage in pelvic fracture.Injury. 2006; 37: 602-613
- Hemorrhage in pelvic fracture: who needs angiography?.Curr Opin Crit Care. 2003; 9: 515-523
- Clinical review: initial management of blunt pelvic trauma patients with haemodynamic instability.Crit Care. 2007; 11https://doi.org/10.1186/cc5157
- Damage control orthopaedics in unstable pelvic ring injuries.Injury. 2004; 35: 671-677
- Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference?.J Trauma. 2005; 58: 778-782
- Management of hemorrhage in severe pelvic injuries.J Trauma. 2010; 68: 415-420
- Direct retroperitoneal pelvic packing versus pelvic angiography: a comparison of two management protocols for haemodynamically unstable pelvic fractures.Injury. 2009; 40: 54-60
- Developing Australia's first statewide trauma registry – what are the lessons?.Aust N Z J Surg. 2004; 74: 424-428
- The trauma registry as a state-wide quality improvement tool.J Trauma. 2005; 59: 1469-1476
- Applied logistic regression.2nd ed. John Wiley & Sons, Inc., New York2000
- Preperitoneal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift.J Trauma. 2007; 62: 834-842
- Effects of early use of external pelvic compression on transfusion requirements and mortality in pelvic fractures.Am J Surg. 2007; 194: 720-723
- Mortality in patients with pelvic fractures: results from the German Pelvic Injury Register.J Trauma. 2008; 64: 449-455
- Predicting major haemmorhage in patients with pelvic fracture.J Trauma. 2006; 61: 346-352
- Emergent management of pelvic ring injuries: an update.Can J Surg. 2005; 48: 49-56
- Pelvic fractures.Emerg Clin North Am. 2007; 25: 795-802
- Management guideline in haemodynamically unstable patients with pelvic fractures: outcomes and challenges.Emerg Med Aust. 2010; 22: 556-564
Article info
Publication history
Accepted:
June 3,
2011
Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
