What are Predictors of Mortality in Patients with Pelvic Fractures?
Our knowledge of factors influencing mortality of patients with pelvic ring injuries and the impact of associated injuries is currently based on limited information.
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.
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).
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).
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.
KeywordsInjury Severity Score Pelvic Fracture Massive Bleeding Pelvic Ring Multiple Trauma
We thank all members of the Pelvic Trauma Working Group of the German Trauma Association. Without their efforts the German Pelvic Trauma Registry and this study would not have been possible. We thank R. Kurowski, H. Neuhäuser, and S. Drum, Center for Clinical Studies of the Department of Trauma, Hand, and Reconstructive Surgery, University of Homburg for their ongoing support in data entry and processing. Institutions contributing to the German Pelvic Trauma Registry: AZ Groeninge Hospital, Kortrijk, Belgium; BG Trauma Hospital, Halle, Germany; BG Trauma Hospital, Tübingen, Germany; BG Trauma Hospital, Ludwigshafen, Germany; BG Trauma Hospital, Murnau, Germany; German Army Hospital, Ulm, Germany; Charité Virchow Campus, Berlin, Germany; Friederikenstift Hospital, Hannover, Germany; University Hospital, Regensburg, Germany; General Hospital, Ludwigsburg, Germany; Hospital of the Technical University, Munich, Germany; General Hospital, Augsburg, Germany; General Hospital, Dortmund, Germany; General Hospital, Biberach, Germany; Medical University, Hannover, Germany; University Hospital Aachen, Germany; SKM Hospital, Koblenz, Germany; Municipal Hospital, Braunschweig, Germany; Municipal Hospital, Karlsruhe, Germany; University Hospital, Magdeburg, Germany; University Hospital, Kiel, Germany; University Hospital, Mainz, Germany; University Hospital, Halle, Germany; University Hospital, Freiburg, Germany; University Hospital, Jena, Germany; University Hospital, Münster, Germany; University Hospital, Homburg, Germany; University Hospital, Leipzig, Germany; University Hospital, Hamburg, Germany; University Hospital, Ulm, Germany; Westpfalz Hospital, Kaiserslautern, Germany.
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