Top

European Journal of Trauma and Emergency Surgery

Published in:

01-04-2018 | Original Article

Impact of pelvic fractures on the early clinical outcomes of severely injured trauma patients

Authors: K. Almahmoud, R. Pfeifer, K. Al-Kofahi, A. Hmedat, W. Hyderabad, F. Hildebrand, A. B. Peitzman, H.-C. Pape

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2018

Abstract

Background

Pelvic fractures contribute to morbidity and mortality following injury. We sought to study the impact of pelvic fractures on the clinical course and outcomes of trauma patients with a pelvic fracture in comparison to patients with similar injury severity without pelvic fracture to identify potential parameters to track patients’ clinical course post-injury.

Methods

A cohort of 206 consecutive blunt trauma survivors, studied over a 5-year period in a level I trauma center of which 75 patients (36.4%) had a pelvic fracture, was included in the study. To perform a retrospective cohort study with matched controls, 60 patients of the pelvic fracture group [(PF), 41 males and 19 females; age: 40 ± 17; injury severity score (ISS): 26.6 ± 9.3] were compared to 60 patients without pelvic fracture (non-PF) trauma as controls (41 males and 19 females; age: 40 ± 13; ISS: 26.9 ± 7.7), both with matching age (±5 years), sex, and ISS (±5 points).

Results

Statistically significant differences were observed in Intensive Care Unit (ICU) length of stay (LOS), total LOS, and Marshall MOD score between PF and non-PF groups, respectively. Acid–base markers such as pH, lactate, LDH, and base deficit were all significantly altered in PF compared to non-PF cohort upon admission. Moreover, our analysis showed significant differences in inflammatory biomarkers (Prolactin, CRP, and IL-6), and clinical parameters (CPK, Hgb, Platelets count, and WBC) over the 7-day clinical course in patients with PF when compared to non-PF cohort.

Conclusion

In this matched cohort, patients with pelvic fractures exhibited biochemical and physiological alterations upon admission. Furthermore, our results suggest that pelvic fracture affects the clinical outcomes in severely injured patients, independently of injury severity, mechanism of injury, age or gender.

Pejcic T, Loncar Z, Rafailovic D, Acimovic M, Dzamic Z, Hadzi-Djokic J. Genitourinary injuries associated with pelvic fractures. Acta Chir Iugosl. 2013;60(2):117–20.CrossRefPubMed

Nicola R. Early total care versus damage control: current concepts in the orthopedic care of polytrauma patients. ISRN Orthop. 2013;2013:329452. doi:10.1155/2013/329452.CrossRefPubMedPubMedCentral

Giannoudis PV, Grotz MR, Tzioupis C, Dinopoulos H, Wells GE, Bouamra O, et al. Prevalence of pelvic fractures, associated injuries, and mortality: the United Kingdom perspective. J Trauma. 2007;63(4):875–83. doi:10.1097/01.ta.0000242259.67486.15.CrossRefPubMed

Bircher M. Pelvic and acetabular fractures past, present, and future. AODialogue. 2007;01/07:36–39

Mors K, Braun O, Wagner N, Auner B, Voth M, Stormann P, et al. Influence of gender on systemic IL-6 levels, complication rates and outcome after major trauma. Immunobiology. 2016. doi:10.1016/j.imbio.2016.03.005.

Schonenberger A, Billeter AT, Seifert B, Neuhaus V, Trentz O, Turina M. Opportunities for improved trauma care of the elderly - a single center analysis of 2090 severely injured patients. Arch Gerontol Geriatr. 2012;55(3):660–6. doi:10.1016/j.archger.2012.02.013.CrossRefPubMed

Fulkerson EW, Egol KA. Timing issues in fracture management: a review of current concepts. Bull NYU Hosp Jt Dis. 2009;67(1):58–67.PubMed

Flint L, Cryer HG. Pelvic fracture: the last 50 years. J Trauma. 2010;69(3):483–8. doi:10.1097/TA.0b013e3181ef9ce1.CrossRefPubMed

Martin S, Casey N. Haemorrhage requiring embolisation after low energy pelvic fracture in an elderly patient: a case report. Emerg Med J. 2010;27(9):722–3. doi:10.1136/emj.2009.084475.CrossRefPubMed

10.

Fox MA, Mangiante EC, Fabian TC, Voeller GR, Kudsk KA. Pelvic fractures: an analysis of factors affecting prehospital triage and patient outcome. South Med J. 1990;83(7):785–8.CrossRefPubMed

11.

Almahmoud K, Namas RA, Zaaqoq AM, Abdul-Malak O, Namas R, Zamora R, et al. Prehospital hypotension is associated with altered inflammation dynamics and worse outcomes following blunt trauma in humans. Crit Care Med. 2015;43(7):1395–404. doi:10.1097/CCM.0000000000000964.CrossRefPubMed

12.

Almahmoud K, Namas RA, Abdul-Malak O, Zaaqoq AM, Zamora R, Zuckerbraun BS, et al. Impact of injury severity on dynamic inflammation networks following blunt trauma. Shock. 2015;44(2):101–9. doi:10.1097/SHK.0000000000000395.CrossRefPubMedPubMedCentral

13.

Almahmoud K, Teuben M, Andruszkow H, Horst K, Lefering R, Hildebrand F, et al. Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®. Patient Saf Surg. 2016;10(1):24. doi:10.1186/s13037-016-0109-6.CrossRefPubMedPubMedCentral

14.

Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.CrossRefPubMed

15.

Gennarelli TA, Wodzin E. AIS 2005: a contemporary injury scale. Injury. 2006;37(12):1083–91. doi:10.1016/j.injury.2006.07.009.CrossRefPubMed

16.

Audige L, Bhandari M, Kellam J. How reliable are reliability studies of fracture classifications? A systematic review of their methodologies. Acta Orthop Scand. 2004;75(2):184–94. doi:10.1080/00016470412331294445.CrossRefPubMed

17.

Zenati MS, Billiar TR, Townsend RN, Peitzman AB, Harbrecht BG. A brief episode of hypotension increases mortality in critically ill trauma patients. JTrauma. 2002;53(2):232–6.

18.

Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23(10):1638–52.CrossRefPubMed

19.

Sauaia A, Moore EE, Johnson JL, Ciesla DJ, Biffl WL, Banerjee A. Validation of postinjury multiple organ failure scores. Shock. 2009;31(5):438–47. doi:10.1097/SHK.0b013e31818ba4c6.CrossRefPubMedPubMedCentral

20.

Sperry JL, Friese RS, Frankel HL, West MA, Cuschieri J, Moore EE et al. Male gender is associated with excessive IL-6 expression following severe injury. The Journal of trauma. 2008;64(3):572–8. doi:10.1097/TA.0b013e3181650fdf (discussion 8–9).CrossRefPubMed

21.

Jastrow KM, Gonzalez EA, McGuire MF, Suliburk JW, Kozar RA, Iyengar S, et al. Early cytokine production risk stratifies trauma patients for multiple organ failure. J Am Coll Surg. 2009;209(3):320–31. doi:10.1016/j.jamcollsurg.2009.05.002.CrossRefPubMed

22.

Gustavo Parreira J, Coimbra R, Rasslan S, Oliveira A, Fregoneze M, Mercadante M. The role of associated injuries on outcome of blunt trauma patients sustaining pelvic fractures. Injury. 2000;31(9):677–82.CrossRefPubMed

23.

Cordts Filho Rde M, Parreira JG, Perlingeiro JA, Solda SC, Campos T, Assef JC. Pelvic fractures as a marker of injury severity in trauma patients. Rev Col Bras Cir. 2011;38(5):310–6.CrossRefPubMed

24.

Berg RJ, Okoye O, Teixeira PG, Inaba K, Demetriades D. The double jeopardy of blunt thoracoabdominal trauma. ArchSurg. 2012;147(6):498–504. p[doi].

25.

DeLong WG, Jr., Born CT. Cytokines in patients with polytrauma. Clin Orthop Relat Res. 2004(422):57–65.

26.

Lenz A, Franklin GA, Cheadle WG. Systemic inflammation after trauma. Injury. 2007;38(12):1336–45. doi:10.1016/j.injury.2007.10.003.CrossRefPubMed

27.

Sperry JL, Friese RS, Frankel HL, West MA, Cuschieri J, Moore EE, et al. Male gender is associated with excessive IL-6 expression following severe injury. JTrauma. 2008;64(3):572–8. doi:10.1097/TA.0b013e3181650fdf.

28.

Maier B, Lefering R, Lehnert M, Laurer HL, Steudel WI, Neugebauer EA, et al. Early versus late onset of multiple organ failure is associated with differing patterns of plasma cytokine biomarker expression and outcome after severe trauma. Shock. 2007;28(6):668–74.PubMed

29.

Rice PL Jr, Rudolph M. Pelvic fractures. Emerg Med Clin North Am. 2007;25(3):795–802. doi:10.1016/j.emc.2007.06.011.

30.

Hou Z, Smith WR, Strohecker KA, Bowen TR, Irgit K, Baro SM, et al. Hemodynamically unstable pelvic fracture management by advanced trauma life support guidelines results in high mortality. Orthopedics. 2012;35(3):e319–e24. doi:10.3928/01477447-20120222-29.PubMed

Title: Impact of pelvic fractures on the early clinical outcomes of severely injured trauma patients
Authors: K. Almahmoud
R. Pfeifer
K. Al-Kofahi
A. Hmedat
W. Hyderabad
F. Hildebrand
A. B. Peitzman
H.-C. Pape
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 2/2018
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-016-0754-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Impact of pelvic fractures on the early clinical outcomes of severely injured trauma patients

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2018

In-screw cement augmentation for iliosacral screw fixation in posterior ring pathologies with insufficient bone stock

Focus on high energy pelvic trauma

Admission delays’ magnitude of traumatized patients in the emergency department of a hospital in Egypt: a cross-sectional study

High fibrin/fibrinogen degradation product to fibrinogen ratio is associated with 28-day mortality and massive transfusion in severe trauma

Multidisciplinary team approach to traumatic spinal cord injuries: a single institution’s quality improvement project

A retrospective evaluation of the Modified Alvarado Score for the diagnosis of acute appendicitis in HIV-infected patients