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Impact of pelvic fractures on the early clinical outcomes of severely injured trauma patients

  • K. Almahmoud
  • R. Pfeifer
  • K. Al-Kofahi
  • A. Hmedat
  • W. Hyderabad
  • F. Hildebrand
  • A. B. Peitzman
  • H.-C. Pape
Original Article

Abstract

Background

Pelvic fractures contribute to morbidity and mortality following injury. We sought to study the impact of pelvic fractures on the clinical course and outcomes of trauma patients with a pelvic fracture in comparison to patients with similar injury severity without pelvic fracture to identify potential parameters to track patients’ clinical course post-injury.

Methods

A cohort of 206 consecutive blunt trauma survivors, studied over a 5-year period in a level I trauma center of which 75 patients (36.4%) had a pelvic fracture, was included in the study. To perform a retrospective cohort study with matched controls, 60 patients of the pelvic fracture group [(PF), 41 males and 19 females; age: 40 ± 17; injury severity score (ISS): 26.6 ± 9.3] were compared to 60 patients without pelvic fracture (non-PF) trauma as controls (41 males and 19 females; age: 40 ± 13; ISS: 26.9 ± 7.7), both with matching age (±5 years), sex, and ISS (±5 points).

Results

Statistically significant differences were observed in Intensive Care Unit (ICU) length of stay (LOS), total LOS, and Marshall MOD score between PF and non-PF groups, respectively. Acid–base markers such as pH, lactate, LDH, and base deficit were all significantly altered in PF compared to non-PF cohort upon admission. Moreover, our analysis showed significant differences in inflammatory biomarkers (Prolactin, CRP, and IL-6), and clinical parameters (CPK, Hgb, Platelets count, and WBC) over the 7-day clinical course in patients with PF when compared to non-PF cohort.

Conclusion

In this matched cohort, patients with pelvic fractures exhibited biochemical and physiological alterations upon admission. Furthermore, our results suggest that pelvic fracture affects the clinical outcomes in severely injured patients, independently of injury severity, mechanism of injury, age or gender.

Keywords

Trauma Injury Pelvic fracture Damage control Clinical outcomes Clinical parameters 

Abbreviations

AIS

Abbreviated injury scale

ISS

Injury severity score

ICU

Intensive care unit

LOS

Length of stay

MODS

Multiple organ dysfunction syndrome

ATLS

Advanced trauma life support

BD

Base deficit

LDH

Lactate dehydrogenase

CPK

Creatine phosphokinase

CRP

C-reactive protein

IL

Interleukin

Notes

Compliance with ethical standards

This study was approved by the University of Aachen Medical Center Institutional Review Board. The work was performed in accordance with internationally accepted ethical standards.

Conflict of interest

All authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of Orthopaedic Trauma SurgeryUniversity of Aachen Medical CentreAachenGermany
  2. 2.Department of Surgery, Division of Trauma and Critical Care SurgeryUniversity of PittsburghPittsburghUSA
  3. 3.Department of Molecular BioscienceUniversity of KansasKansasUSA
  4. 4.Department of General SurgeryMethodist Dallas Health SystemDallasUSA

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