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Published on: August 17, 2017
Early predictors of mortality in hemodynamically unstable pelvis fractures
Wade Smith1, Allison Williams, Juan Agudelo
1Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA. wsmith@dhha.org
Insights
Early identification of mortality risk in hemodynamically unstable pelvic fracture patients is crucial. The Revised Trauma Score (RTS), Injury Severity Score (ISS), age, and blood transfusion requirements predict survival in these critical cases.
Area of Science:
- Trauma surgery
- Emergency medicine
- Orthopedic surgery
Background:
- Hemodynamically unstable patients with pelvic ring injuries face high mortality.
- Early identification of mortality predictors is essential for timely intervention.
Purpose of the Study:
- To identify reliable, early indicators of mortality and causes of death in hemodynamically unstable patients with pelvic ring injuries.
Main Methods:
- Retrospective review of a prospective pelvic trauma database.
- Included 187 hemodynamically unstable patients with pelvic fractures.
- Analyzed Injury Severity Score (ISS), Revised Trauma Score (RTS), age, blood transfusion, and multisystem organ failure (MOF).
Main Results:
- The Injury Severity Score (ISS), Revised Trauma Score (RTS), age over 60, and blood transfusion were significant predictors of mortality.
- The RTS was the most predictive single variable, but a model combining all four variables was superior.
- Most deaths were due to exsanguination (74.4%) or multisystem organ failure (17.9%).
Conclusions:
- Early predictors of mortality are vital for effective treatment of pelvic fracture patients.
- Deaths within 24 hours were primarily from acute blood loss; later deaths were mainly due to MOF.
- Improving survival necessitates advancements in early hemorrhage control and resuscitation strategies.
Objectives:
To determine reliable, early indicators of mortality and causes of death in hemodynamically unstable patients with pelvic ring injuries.
Design:
This was a retrospective review of a prospective pelvic database.
Methods:
In all, 187 hemodynamically unstable patients with pelvic fractures (persistent systolic blood pressure <90 mm Hg after receiving 2 L of intravenous crystalloid) admitted from April 1998 to November 2004 were included. Intervention was Level 1 Trauma Center-Pelvis Fracture standardized protocol. Main outcome measurements were: Injury Severity Score (ISS), Revised Trauma Score (RTS), age, blood transfusion, mortality, and multisystem organ failure (MOF).
Results:
Group 1 (39 patients) did not survive their injury. Group 2 (148 patients) survived their injury. Fracture pattern (chi(2) = 9.1, P = 0.33), and treatment with angiography/embolization (chi(2) = 0.054, P = 0.84) were not predictive of death. Patients requiring more blood had a statistically significant higher mortality rate. The ISS (t = -5.62, P < 0.001), RTS (t = 6.10, P < 0.001), age >60 years old (chi(2) = 5.4, P = 0.03), and transfusion (t = -2.70, P = 0.010) were statistically significant independent predictors of mortality. A logistic regression analysis and receiver operating characteristic curves indicated that of these variables, RTS was the most predictive independent variable. However, a model including all four variables was superior at predicting mortality. Most deaths were attributed to exsanguination (74.4%) or MOF (17.9%).
Conclusions:
Predictors of mortality in pelvis fracture patients should be available early in the course of treatment in order to be useful. Death within 24 hours was most often a result of acute blood loss while death after 24 hours was most often caused by MOF. Improved survival will depend upon the evolution of early hemorrhage control and resuscitative strategies in patients at high mortality risk.
