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Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes
Demetrios Demetriades1, Marios Karaiskakis, Konstantinos Toutouzas
1Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA.
Insights
This study identifies key risk factors for severe pelvic fractures, associated abdominal injuries, and mortality in blunt trauma patients. Understanding these factors aids in selecting appropriate diagnostic and therapeutic interventions for better patient outcomes.
Area of Science:
- Trauma surgery and epidemiology.
- Injury biomechanics and outcomes.
Background:
- Pelvic fractures frequently involve severe intraabdominal injuries or significant hemorrhage.
- Identifying risk factors for associated injuries and mortality is crucial for trauma management.
Purpose of the Study:
- To investigate the epidemiology of pelvic fractures.
- To identify risk factors for associated abdominal injuries, bleeding, need for angiographic embolization, and death.
Main Methods:
- Analysis of a trauma registry for blunt pelvic fractures.
- Utilized stepwise logistic regression to identify risk factors for fracture severity, associated injuries, transfusion, embolization, and mortality.
- Calculated adjusted relative risks and 95% confidence intervals.
Main Results:
- 1,545 (9.3%) of 16,630 blunt trauma patients had pelvic fractures.
- Abdominal injuries occurred in 16.5% of pelvic fracture patients, most commonly liver and bladder/urethra.
- Severe pelvic fractures (AIS ≥4) had a 30.7% incidence of intraabdominal injuries, with bladder/urethra most common (14.6%).
- Motor vehicle crashes were negatively associated with severe pelvic fractures.
- Risk factors for major blood loss included older age, severe pelvic fracture, angiographic embolization, and high Injury Severity Score (ISS).
- Age > 55 predicted aortic injury; pelvic AIS ≥4 and ISS > 25 predicted need for angiographic embolization.
- Overall mortality was 13.5%, with ISS > 25 being the primary mortality predictor.
Conclusions:
- Epidemiological variables significantly predict pelvic fracture severity, associated abdominal injuries, blood loss, and the need for angiography.
- These identified risk factors are valuable for guiding diagnostic and therapeutic strategies in managing pelvic fractures.
Background:
Pelvic fractures are often associated with major intraabdominal injuries or severe bleeding from the fracture site.
Objective:
To study the epidemiology of pelvic fractures and identify important risk factors for associated abdominal injuries, bleeding, need for angiographic embolization, and death.
Methods:
Trauma registry study on pelvic fractures from blunt trauma. Stepwise logistic regression was used to identify risk factors of severe pelvic fractures, associated abdominal injuries, need for major blood transfusion, therapeutic embolization, and death from pelvic fracture. Adjusted relative risks and 95% confidence intervals were derived.
Results:
There were 16,630 trauma registry patients with blunt trauma, of whom 1,545 (9.3%) had a pelvic fracture. The incidence of abdominal injuries was 16.5%, and the most common injured organs were the liver (6.1%) and the bladder and urethra (5.8%). In severe pelvic fractures (Abbreviated Injury Scale [AIS] > or =4), the incidence of associated intraabdominal injuries was 30.7%, and the most commonly injured organs were the bladder and urethra (14.6%). Among the risk factors studied, motor vehicle crash is the only notable risk factor negatively associated with severe pelvic fracture. Major risk factors for associated liver injury were motor vehicle crash and pelvis AIS > or = 4. Risk factors of major blood loss were age > 16 years, pelvic AIS > or =4, angiographic embolization, and Injury Severity Score (ISS) > 25. Age> 55 years was the only predictor for associated aortic injury. Factors associated with therapeutic angiographic embolization were pelvic AIS > or =4 and ISS > 25. The overall mortality was 13.5%, but only 0.8% died as a direct result of pelvic fracture. The only pronounced risk factor associated with mortality was ISS>25.
Conclusions:
Some epidemiological variables are important risk factors of severity of pelvic fractures, presence of associated abdominal injuries, blood loss, and need of angiography. These risk factors can help in selecting the most appropriate diagnostic and therapeutic interventions.
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