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Predictors of mortality after pelvic fractures: a retrospective cohort study from a level one trauma centre in Upper
Amr Eisa1, Osama Farouk2, Dalia G Mahran3
1Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, 71526, Egypt. amr.eisa@aun.edu.eg.
Insights
Predictors of death in pelvic fracture patients include older age, soft tissue injury, head injury, and ICU admission. The first 24 hours are critical for survival in these trauma cases.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Emergency Medicine
Background:
- Pelvic ring injuries are severe trauma with significant mortality.
- Identifying predictors of in-hospital mortality is crucial for patient management.
Purpose of the Study:
- To identify predictors of in-hospital mortality in patients with pelvic ring injuries.
- To analyze mortality differences between adult and pediatric populations.
- To determine the causes and timing of death.
Main Methods:
- Retrospective cohort study of 1188 patients with pelvic ring fractures.
- Data collected from Assiut University Trauma Unit registry (January 2010 - December 2013).
- Univariable and multivariable logistic regression analyses were used to identify predictors.
Main Results:
- In-hospital mortality rate was 8.7% (103 patients).
- Significant predictors of mortality included increasing age, soft tissue injury, head injury, positive FAST exam, and ICU admission.
- Mortality peaked within the first 24 hours and between 48 hours and one week.
Conclusions:
- The initial 24 hours post-injury are critical for survival in pelvic fracture patients.
- Advancing age, associated injuries (soft tissue, head), positive FAST, and ICU admission are reliable predictors of elevated mortality risk.
- These findings aid in risk stratification and targeted interventions for high-risk patients.
Purpose:
The primary objective was to identify the predictors of in-hospital mortality after pelvic ring injuries. Secondary objectives were to analyze the differences between adults and children and to analyze the causes and timing of death.
Methods:
A retrospective cohort study from the pelvic registry of Assiut University Trauma Unit (AUTU), a level 1 trauma centre in Upper Egypt, was carried out. A total of 1188 consecutive patients with pelvic ring fractures treated from January 2010 to December 2013 were eligible for analysis. Potential predictors were identified using standard statistical tests: univariable and multivariable regression analysis.
Results:
Nine hundred fifty-one were adults (above 16 years) and 237 were children. According to Tile's classification, fractures type A, B, and C were 31.8%, 25.1%, and 43.1%, respectively. About a third of patients had fractures with soft tissue injury. Abdominopelvic collection as diagnosed by Focused Assessment with Sonography for Trauma (FAST) was positive in 11%. Associated injuries were present in 67.3% with abdominal-urogenital injuries being the most prevalent (66.3%). Median hospital stay was five days. Fifty-two patients (4.4%) were admitted to the ICU. One hundred three patients died (8.7%) within two peaks: first 24 hours and between 48 hours and one week. Multivariable logistic regression analysis identified increasing age, fractures with soft tissue injury, associated head injury, positive FAST examination, and admission to an ICU as significant predictors of in-hospital mortality.
Conclusions:
The first 24 hours were confirmed to be critical for survival in pelvic fracture patients. Advancing age, associated soft tissue injury, associated head injury, admission to ICU, and positive FAST examination can serve as reliable predictors for an elevated mortality risk in such patients.
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