Predictors of mortality after pelvic fractures: a retrospective cohort study from a level one trauma centre in Upper Egypt
- 47 Downloads
The primary objective was to identify the predictors of in-hospital mortality after pelvic ring injuries. Secondary objectives were to analyze the differences between adults and children and to analyze the causes and timing of death.
A retrospective cohort study from the pelvic registry of Assiut University Trauma Unit (AUTU), a level 1 trauma centre in Upper Egypt, was carried out. A total of 1188 consecutive patients with pelvic ring fractures treated from January 2010 to December 2013 were eligible for analysis. Potential predictors were identified using standard statistical tests: univariable and multivariable regression analysis.
Nine hundred fifty-one were adults (above 16 years) and 237 were children. According to Tile’s classification, fractures type A, B, and C were 31.8%, 25.1%, and 43.1%, respectively. About a third of patients had fractures with soft tissue injury. Abdominopelvic collection as diagnosed by Focused Assessment with Sonography for Trauma (FAST) was positive in 11%. Associated injuries were present in 67.3% with abdominal-urogenital injuries being the most prevalent (66.3%). Median hospital stay was five days. Fifty-two patients (4.4%) were admitted to the ICU. One hundred three patients died (8.7%) within two peaks: first 24 hours and between 48 hours and one week. Multivariable logistic regression analysis identified increasing age, fractures with soft tissue injury, associated head injury, positive FAST examination, and admission to an ICU as significant predictors of in-hospital mortality.
The first 24 hours were confirmed to be critical for survival in pelvic fracture patients. Advancing age, associated soft tissue injury, associated head injury, admission to ICU, and positive FAST examination can serve as reliable predictors for an elevated mortality risk in such patients.
KeywordsPelvic fractures Mortality Predictors Trauma registry
The development of the manuscript was supported by an AOCID fellowship for the first author sponsored by AOTrauma.
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Vasiliki Kalampoki, Anahi Hurtado-Chong and Elke Rometsch are employees of the AO Foundation.
- 9.Kanakaris NK, Greven T, West RM, Van Vugt AB, Giannoudis PV (2017) Implementation of a standardized protocol to manage elderly patients with low energy pelvic fractures: can service improvement be expected? Int Orthop 41(9):1813–1824. https://doi.org/10.1007/s00264-017-3567-2 CrossRefPubMedGoogle Scholar
- 16.Cheng M, Cheung MT, Lee KY, Lee KB, Chan SCH, Wu ACY, Chow YF, Chang AML, Ho HF, Yau KKW (2015) Improvement in institutional protocols leads to decreased mortality in patients with haemodynamically unstable pelvic fractures. Emerg Med J 32(3):214–220. https://doi.org/10.1136/emermed-2012-202009 CrossRefPubMedGoogle Scholar
- 19.Ojodu I, Pohlemann T, Hopp S, Rollmann MFR, Holstein JH, Herath SC (2015) Predictors of mortality for complex fractures of the pelvic ring in the elderly: a twelve-year review from a German level I trauma center. Injury 46(10):1996–1998. https://doi.org/10.1016/j.injury.2015.07.034 CrossRefPubMedGoogle Scholar
- 20.Gansslen A, Hildebrand F, Heidari N, Weinberg A (2012) Pelvic ring injuries in children. Part I: epidemiology and primary evaluation. A review of the literature. Acta Chir Orthop Traumatol Cechoslov 79(6):493–498Google Scholar
- 24.Wang H, Robinson RD, Moore B, Kirk AJ, Phillips JL, Umejiego J, Chukwuma J, Miller T, Hassani D, Zenarosa NR (2016) Predictors of early versus late mortality in pelvic trauma patients. Scand J Trauma Resusc Emerg Med 24. https://doi.org/10.1186/s13049-016-0220-9
- 25.Jawed A, Ahmed A, Williams MR (2018) Intra-operative cell salvage in pelvic and acetabular fracture surgery: a retrospective comparative study. Int Orthop. https://doi.org/10.1007/s00264-018-4104-7
- 32.Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, AlMazroa MA, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Abdulhak AB, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FGR, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo J-P, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Memish ZA, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KMV, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA III, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh P-H, Yip P, Zabetian A, Zheng Z-J, Lopez AD, Murray CJL (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2095–2128. https://doi.org/10.1016/S0140-6736(12)61728-0 CrossRefPubMedGoogle Scholar
- 33.Arroyo W, Nelson KJ, Belmont PJ Jr, Bader JO, Schoenfeld AJ (2013) Pelvic trauma: what are the predictors of mortality and cardiac, venous thrombo-embolic and infectious complications following injury? Injury 44(12):1745–1749. https://doi.org/10.1016/j.injury.2013.08.007 CrossRefPubMedGoogle Scholar
- 34.Wang H, Phillips JL, Robinson RD, Duane TM, Buca S, Campbell-Furtick MB, Jennings A, Miller T, Zenarosa NR, Delaney KA (2015) Predictors of mortality among initially stable adult pelvic trauma patients in the US: data analysis from the National Trauma Data Bank. Injury 46(11):2113–2117. https://doi.org/10.1016/j.injury.2015.08.039 CrossRefPubMedGoogle Scholar