Survival trends and predictors of mortality in severe pelvic trauma: Estimates from the German Pelvic Trauma Registry Initiative

详细信息    查看全文

• 作者：Tim Pohlemann^a ; ¹ ; ^{tim.pohlemann@uks.eu} ; Dirk Stengel^b ; ¹ ; Georgios Tosounidis^a ; ¹ ; Heinrich Reilmann^c ; ¹ ; Fabian Stuby^d ; ¹ ; Uli Stö ; ckle^e ; ¹ ; Andreas Seekamp^f ; ¹ ; Hagen Schmal^g ; ¹ ; Andreas Thannheimer^h ; ¹ ; Francis Holmenschlagerⁱ ; ¹ ; Axel Gä ; nsslen^j ; ¹ ; Pol Maria Rommens^k ; ¹ ; Thomas Fuchs^l ; ¹ ; Friedel Baumgä ; rtel^m ; ¹ ; Ivan Marintschevⁿ ; ¹ ; Gert Krischak^o ; ¹ ; Stephan Wunder^p ; ¹ ; Harald Tscherne^a ; ¹ ; Ulf Culemann^a ; ¹
• 关键词：Pelvic trauma ; Survival ; Epidemiology ; Registry ; Complex injuries
• 刊名：Injury
• 出版年：2011
• 出版时间：October, 2011
• 年：2011
• 卷：42
• 期：10
• 页码：997-1002
• 全文大小：1K

文摘

Study objective

To determine longitudinal trends in mortality, and the contribution of specific injury characteristics and treatment modalities to the risk of a fatal outcome after severe and complex pelvic trauma.

Methods

We studied 5048 patients with pelvic ring fractures enrolled in the German Pelvic Trauma Registry Initiative between 1991 and 1993, 1998 and 2000, and 2004 and 2006. Complete datasets were available for 5014 cases, including 508 complex injuries, defined as unstable fractures with severe peri-pelvic soft tissue and organ laceration. Multivariable mixed-effects logistic regression analysis was employed to evaluate the impact of demographic, injury- and treatment-associated variables on all-cause in-hospital mortality.

Results

All-cause in-hospital mortality declined from 8 % (39/466) in 1991 to 5 % (33/638) in 2006. Controlling for age, Injury Severity Score, pelvic vessel injury, the need for emergency laparotomy, and application of a pelvic clamp, the odds ratio (OR) per annum was 0.94 (95 % confidence interval [CI] 0.91-0.96). However, the risk of death did not decrease significantly in patients with complex injuries (OR 0.98, 95 % CI 0.93-1.03). Raw mortality associated with this type of injury was 18 % (95 % CI 9-32 % ) in 2006.

Conclusion

In contrast to an overall decline in trauma mortality, complex pelvic ring injuries remain associated with a significant risk of death. Awareness of this potentially life-threatening condition should be increased amongst trauma care professionals, and early management protocols need to be implemented to improve the survival prognosis.