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What are predictors of mortality in patients with pelvic fractures?
Joerg H Holstein1, Ulf Culemann, Tim Pohlemann
1Department of Trauma, Hand, and Reconstructive Surgery, University of Saarland, Homburg, Germany. joerg.holstein@uks.eu
Insights
Mortality in pelvic ring injuries is often due to massive bleeding from complex fractures. Nonsurvivors typically present with severe trauma and hemorrhage, highlighting critical factors in pelvic fracture outcomes.
Area of Science:
- Trauma surgery
- Orthopedic surgery
- Emergency medicine
Background:
- Limited understanding of factors influencing mortality in pelvic ring injuries.
- Need for data on associated injuries impacting outcomes.
Purpose of the Study:
- Identify causes and timing of death in patients with pelvic ring fractures.
- Characterize demography, injury patterns, and severity in nonsurvivors.
- Compare nonsurvivors with survivors of pelvic ring fractures.
Main Methods:
- Prospective data collection from the German Pelvic Trauma Registry (2004-2011).
- Inclusion of 5340 patients, with detailed analysis of 238 nonsurvivors.
- Comparison of demographic and injury severity data between survivors and nonsurvivors.
Main Results:
- 4% of patients (238) died, with a median of 2 days post-trauma.
- Massive bleeding (34%) was the primary cause of death, often from the pelvic region (62%).
- Nonsurvivors had higher rates of complex pelvic injuries, lower hemoglobin and blood pressure, and higher Injury Severity Scores (ISS).
Conclusions:
- Nonsurvivors of pelvic fractures are predominantly male.
- Severe multiple trauma and major hemorrhage are key characteristics of nonsurvivors.
- Understanding these factors is crucial for improving outcomes in pelvic ring injuries.
Background:
Our knowledge of factors influencing mortality of patients with pelvic ring injuries and the impact of associated injuries is currently based on limited information.
Questions/Purposes:
We identified the (1) causes and time of death, (2) demography, and (3) pattern and severity of injuries in patients with pelvic ring fractures who did not survive.
Methods:
We prospectively collected data on 5340 patients listed in the German Pelvic Trauma Registry between April 30, 2004 and July 29, 2011; 3034 of 5340 (57%) patients were female. Demographic data and parameters indicating the type and severity of injury were recorded for patients who died in hospital (nonsurvivors) and compared with data of patients who survived (survivors). The median followup was 13 days (range, 0-1117 days).
Results:
A total of 238 (4%) patients died a median of 2 days after trauma. The main cause of death was massive bleeding (34%), predominantly from the pelvic region (62% of all patients who died because of massive bleeding). Fifty-six percent of nonsurvivors and 43% of survivors were male. Nonsurvivors were characterized by a higher incidence of complex pelvic injuries (32% versus 8%), less isolated pelvic ring fractures (13% versus 49%), lower initial blood hemoglobin concentration (6.7 ± 2.9 versus 9.8 ± 3.0 g/dL) and systolic arterial blood pressure (77 ± 27 versus 106 ± 24 mmHg), and higher injury severity score (ISS) (35 ± 16 versus 15 ± 12).
Conclusion:
Patients with pelvic fractures who did not survive were characterized by male gender, severe multiple trauma, and major hemorrhage.
Level Of Evidence:
Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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