Blunt trauma pelvic fracture-associated genitourinary and concomitant lower gastrointestinal injury: incidence, morbidity, and mortality

Abstract

Purpose

Limited data exist on the characteristics, risk factors, and management of blunt trauma pelvic fractures causing genitourinary (GU) and lower gastrointestinal (GI) injury. We sought to determine these parameters and elucidate independent risk factors.

Methods

The National Trauma Data Bank for years 2010–2014 was queried for pelvic fractures by ICD-9-CM codes. Exclusion criteria included age ≤ 17 years, penetrating injury, or incomplete records. Patients were divided into three cohorts: pelvic fracture, pelvic fracture with GU injury, and pelvic fracture with GU and GI injury. Between-group comparisons were made using stratified analysis. Multivariable logistic regression was used to determine independent risk factors for concomitant GI injury.

Results

In total, 180,931 pelvic fractures were found, 3.3% had GU, and 0.15% had GU and GI injury. Most common mechanism was vehicular collision. Injury severity score, pelvic AIS, and mortality were higher with combined injury (p < 0.001), leading to longer hospital and ICU stays and ventilator days (p < 0.001) with more frequent discharges to acute rehabilitation (p < 0.01). Surgical management of concomitant injuries involved both urinary (62%) and rectal repairs (81%) or diversions (29% and 46%, respectively). Male gender (OR = 2.42), disruption of the pelvic circle (OR = 6.04), pubis fracture (OR = 2.07), innominate fracture (OR = 1.84), and SBP < 90 mmgh (OR = 1.59) were the strongest independent predictors of combined injury (p < 0.01).

Conclusion

Pelvic fractures with lower GU and GI injury represent < 1% of pelvic fractures. They are associated with more severe injuries and increased hospital resource utilization. Strongest independent predictors are disruption of the pelvic circle, male gender, innominate fracture, and SBP < 90mm Hg.

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Acknowledgements

Committee on Trauma, American College of Surgeons, NTDB version, Chicago, IL, 2015. The content reproduced from the NTDB remains the full and exclusive copyrighter property of the American College of Surgeons. The American College of Surgeons is not responsible for any claims arising from works based on the original data, text, tables, or figures.

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Contributions

NV and RJaF developed the project and wrote the manuscript; RJoF helped in project development, data collection and management; SK contributed to data collection and management and data analysis; MAB developed the project and wrote and edited the manuscript.

Corresponding author

Correspondence to Marc A. Bjurlin.

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The authors declare that they have no conflict of interest.

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This is a retrospective study, conducted on already available data. It did not necessitate IRB approval at our institution. Separate informed consent was not necessary as data are obtained from a national repository in a de-identified manner. The authors attest that this article does not contain any studies with human participants or animals performed by any of the authors.

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Velazquez, N., Fantus, R.J., Fantus, R.J. et al. Blunt trauma pelvic fracture-associated genitourinary and concomitant lower gastrointestinal injury: incidence, morbidity, and mortality. World J Urol 38, 231–238 (2020). https://doi.org/10.1007/s00345-019-02725-7

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Keywords

  • Trauma
  • GI injury
  • GU injury