Traumatic Injury in Pregnancy: A Propensity Score-Matched Analysis

Area of Science:

• Trauma Surgery
• Maternal Health
• Emergency Medicine

Background:

• Trauma is a leading cause of nonobstetrical maternal death.
• In-hospital outcomes for acutely injured pregnant patients (PPs) compared to nonpregnant control groups (CGs) are not well-described.
• A hypothesis posited worse outcomes for PPs after acute trauma.

Purpose of the Study:

• To compare in-hospital outcomes of traumatically injured pregnant patients (PPs) with similarly aged nonpregnant control groups (CGs).
• To identify differences in mortality, disposition, length of stay (LOS), and complications between PPs and CGs.

Main Methods:

• Utilized the American College of Surgeons Trauma Quality Improvement Program (TQIP) database from 2017-2019.
• Employed propensity score matching based on age, race, injury severity score, and trauma type to create comparable PP and CG cohorts.
• Primary outcomes analyzed included mortality, disposition, LOS, and complication rates.

Main Results:

• A total of 1078 traumatically injured pregnant females were identified, with 990 patients in the matched PP and CG cohorts.
• Pregnant patients were more likely to be assault victims (11% vs. 6%) and had longer LOS (5 days vs. 3 days).
• PPs showed higher rates of mechanical ventilation (26% vs. 16%), ICU admission (44% vs. 32%), and direct OR transfer (34% vs. 15%), with similar complication and mortality rates.

Conclusions:

• Acutely injured pregnant patients do not have increased mortality or complications compared to matched nonpregnant controls.
• Pregnant patients are more likely to be assault victims, require mechanical ventilation or ICU admission, and experience longer hospital stays after trauma.
• Outcomes such as emergency department discharge were less frequent in pregnant patients.