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What are Predictors of Mortality in Patients with Pelvic Fractures?

  • Symposium: Disruptions of the Pelvic Ring: An Update
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Our knowledge of factors influencing mortality of patients with pelvic ring injuries and the impact of associated injuries is currently based on limited information.

Questions/purposes

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.

Methods

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).

Results

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).

Conclusion

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.

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Acknowledgments

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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Authors and Affiliations

  1. Department of Trauma, Hand, and Reconstructive Surgery, University of Saarland, Kirrberger Strasse 1, 66421, Homburg, Germany

    Joerg H. Holstein MD, Ulf Culemann MD & Tim Pohlemann MD

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  1. Joerg H. Holstein MD
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  2. Ulf Culemann MD
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  3. Tim Pohlemann MD
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Working Group Mortality in Pelvic Fracture Patients

Corresponding author

Correspondence to Joerg H. Holstein MD.

Additional information

The members of the Working Group Mortality in Pelvic Fracture Patients are:

Georgios Tosounidis, MD

Markus Burkhardt, MD

Department of Trauma, Hand, and Reconstructive Surgery, University of Saarland, Homburg, Germany

Emin Aghayev, MD

Institute for Evaluative Research in Medicine, University of Bern, Bern, Switzerland

Jörg Böhme, MD

University Hospital Leipzig, Leipzig, Germany

Hagen Schmal, MD

University Hospital Freiburg, Freiburg, Germany

Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. The institutional review boards of all investigational sites approved the study, and waived written informed consent because of the use of routine administrative hospital data.

Data were collected at the collaborating institutions as reported in the Acknowledgement section and analyzed at the Department of Trauma, Hand, and Reconstructive Surgery, University of Saarland, and the Institute for Evaluative Research in Medicine at the University of Bern.

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Holstein, J.H., Culemann, U., Pohlemann, T. et al. What are Predictors of Mortality in Patients with Pelvic Fractures?. Clin Orthop Relat Res 470, 2090–2097 (2012). https://doi.org/10.1007/s11999-012-2276-9

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