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Improvement of outcomes in patients with pelvic fractures and hemodynamic instability after the establishment of a Korean regional trauma center

Abstract

Purpose

Despite using a multidisciplinary treatment approach, the mortality rate of patients with hemodynamic instability from severe pelvic fractures is still 40–60%. We evaluated the improvement of outcomes in this patient population after the establishment of a regional trauma center in Korea.

Methods

We retrospectively reviewed the medical charts of 50 patients with hemodynamic instability due to pelvic fractures between March 2011 and November 2016. Patients were divided into two groups: the pre-trauma center (PTC) group (n = 23) and trauma center (TC) group (n = 27).

Results

Sixteen (32.0%) patients died of exsanguination. Patients in the TC group had shorter trauma resuscitation room stay (101 vs 273 min, p < 0.001) and underwent preperitoneal pelvic packing (PPP) more frequently (88.9 vs 8.7%, p < 0.001) than those in the PTC group. During the TC period, emergent procedures such as PPP and pelvic angiography were performed more frequently (92.6 vs 39.1%, p < 0.001). Although there was no statistical difference in the overall mortality rate between groups, patients in the TC group had less mortality due to hemorrhage (18.5 vs 47.8%, p = 0.027). Logistic regression analysis demonstrated that initial systolic blood pressure and establishment of trauma center were independent protective factors of mortality from hemorrhage [odds ratio (OR) 0.957, 95% confidence interval (CI) 0.926–0.988, p = 0.007; OR 0.134, 95% CI 0.028–0.633, p = 0.011].

Conclusions

Since the regional trauma center was established, emergent procedures such as pelvic angiography and PPP were performed more frequently, and mortality due to exsanguination was significantly decreased.

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Acknowledgements

We thank the staff of all the regional trauma centers in Korea for their enthusiasm and commitment to patient care. The authors confirm that were not in receipt of any grants.

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Correspondence to Hoon Ryu.

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There are no potential conflicts of interest for each of the authors.

Ethics statement

The present study protocol was reviewed and approved by the institutional review board of Wonju Severance Christian Hospital (Reg. No. CR316111). Informed consent was exempted, because it was a retrospective study.

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Jang, J.Y., Shim, H., Kwon, H.Y. et al. Improvement of outcomes in patients with pelvic fractures and hemodynamic instability after the establishment of a Korean regional trauma center. Eur J Trauma Emerg Surg 45, 107–113 (2019). https://doi.org/10.1007/s00068-017-0886-3

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Keywords

  • Pelvis
  • Hemorrhage
  • Trauma center
  • Preperitoneal pelvic packing
  • Damage control