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Pelvic Ring Injury Mortality: Are We Getting Better?
Lucas S Marchand1, Aresh Sepehri2, Zachary D Hannan1
1R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and.
Insights
Mortality rates for pelvic ring injuries significantly decreased from 9.1% to 4.9% due to improved trauma care and resuscitation protocols. These advancements in managing severe hemorrhagic shock have led to better outcomes for patients with pelvic trauma.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Emergency Medicine
Background:
- Pelvic ring injuries are associated with high mortality rates.
- Changes in trauma care protocols may influence patient outcomes.
- Evaluating temporal trends in mortality is crucial for assessing treatment effectiveness.
Purpose of the Study:
- To investigate the impact of evolving pelvic trauma care and treatment protocols on overall mortality rates following pelvic ring injuries.
- To compare mortality rates between different time periods of pelvic ring management.
Main Methods:
- Retrospective cohort study including 3314 patients with pelvic ring injuries from 1999 to 2018.
- Comparison of pelvic ring management between two distinct periods: 1999-2006 and 2007-2018.
- Analysis of in-hospital mortality, adjusting for patient demographics, fracture characteristics, and injury severity scores.
Main Results:
- Overall mortality rate was 6.5% (214/3314).
- Mortality decreased significantly from 9.1% in the earlier period (1999-2006) to 4.9% in the later period (2007-2018).
- Adjusted analysis revealed a more pronounced mortality reduction (6.4%) in the recent period, indicating improved outcomes.
Conclusions:
- Significant improvements in survival rates for pelvic ring injuries have been observed in recent years.
- These improvements correlate with advancements in trauma resuscitation and adjuvant treatments for hemorrhagic shock.
- Further research is needed to elucidate the specific benefits of individual treatments, but current data suggest enhanced care over time.
Objectives:
To determine if changes in pelvic trauma care and treatment protocols have affected overall mortality rates after pelvic ring injury.
Design:
Retrospective cohort study.
Setting:
Level I trauma center.
Patients/Participants:
A total of 3314 patients with pelvic ring injuries who presented to a single referral center from 1999 to 2018 were included in the study.
Intervention:
Pelvic ring management, years 1999-2006 versus years 2007-2018.
Main Outcome Measurements:
In hospital mortality. Other examined variables included change in patient demographics, fracture characteristics, date of injury, associated injuries, length of hospital stay, Abbreviated Injury Severity Score.
Results:
The composite mortality rate was 6.5% (214/3314). The earliest cohort presented a mortality rate of 9.1% [111/1224; 95% confidence interval (CI), 7.6%-10.8%] compared with the more recent cohort mortality rate of 4.9% (103/2090; 95% CI, 4.1%-5.9%). Overall mortality was significantly lower in the more recent period, a risk difference of 4.1% (95% CI, 2.3%-6.1%; P < 0.01). After adjusting for age and Abbreviated Injury Severity Score of the brain, chest, and abdomen, the mortality reduction was more pronounced with an adjusted risk difference of 6.4% (95% CI, 4.7%-8.1%; P < 0.01).
Conclusion:
Significant improvement in the mortality rate of pelvic ring injuries has been demonstrated in recent years (4.9% vs. 9.1%) and the difference is even large when accounting for known confounders. Improvement appears to coincide chronologically with changes in trauma resuscitation and implementation of adjuvant treatments for managing patients with severe hemorrhagic shock. Although the exact benefit of each treatment awaits further research, these data might indicate improved care over time for these difficult patients.
Level Of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
