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Predictors of mortality following severe pelvic ring fracture: results of a population-based study
Belinda J Gabbe1, Richard de Steiger, Max Esser
1Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. belinda.gabbe@monash.edu
Insights
Severe pelvic ring fractures are high-risk injuries. Key mortality predictors include advanced age, hypotension, and severe chest trauma, emphasizing the need for hemodynamic stability management.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Public Health
Background:
- Severe pelvic ring fractures are uncommon but carry a high mortality risk.
- These injuries often result from high-energy blunt trauma, frequently accompanied by other severe injuries.
- Effective management strategies are crucial for this patient group.
Purpose of the Study:
- To identify predictors of mortality in patients with severe pelvic ring fractures.
- To analyze data from a regionalized trauma system to understand mortality factors.
- To inform clinical practice and improve outcomes for patients with pelvic ring injuries.
Main Methods:
- A population-based study utilizing data from the Victorian State Trauma Registry (2001-2008).
- Inclusion criteria: patients aged 15 years and older.
- Multivariate logistic regression analysis was employed to determine mortality predictors, calculating adjusted odds ratios (AOR) and 95% confidence intervals (CI).
Main Results:
- The study included 348 cases with a 19% mortality rate.
- Mortality risk was significantly higher in patients aged 65 years and older (AOR 7.6) and those with hypotension (AOR 5.5 at scene, AOR 3.7 on arrival).
- Severe chest injury (AOR 2.8) and intentional injury mechanisms (AOR 4.9) also increased mortality risk; hospital of management did not significantly impact outcomes.
Conclusions:
- Effective control of hemodynamic instability is critical for reducing mortality in severe pelvic ring fractures.
- Given that most patients survive, future research should investigate long-term morbidity and treatment impacts.
- This study underscores the importance of early resuscitation and management of shock in trauma patients.
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.
