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International Journal of Emergency Medicine

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Open Access 01-12-2010 | Original Research Article

Patients with pelvic fracture: what factors are associated with mortality?

Authors: Chee Kheong Ooi, Hsin K. Goh, Seow Y. Tay, Dong H. Phua

Published in: International Journal of Emergency Medicine | Issue 4/2010

Abstract

Background

Pelvic fracture is one of the major injuries that lead to death in patients who sustain high-impact injuries such as road traffic accidents and falls from height.

Aims

This study aims to look at the epidemiology and the significant predictors of mortality in victims with pelvic fracture presenting to the emergency department (ED) of an urban Asian city.

Methods

This was a retrospective data analysis of all trauma patients with pelvic fracture who were treated at the ED of an urban adult hospital in Singapore from April 2001 to December 2004. Student’s t-test and χ² test were used in statistical analysis where appropriate.

Results

The study included 179 consecutive patients. Sixty-four percent of patients were males, and 71% of patients were in the 20–49-year-old age group. Road traffic accidents and falls from height were the two most common mechanisms of injury. Mortality rate was 37%. Pelvic fracture severity, shock and coma at presentation, and the presence of concurrent head and chest injuries were associated with increased mortality. Gender, other mechanisms of injury and other concomitant injuries were not associated with increased mortality.

Conclusions

The mortality rate of trauma patients with pelvic fracture continues to be high. In such patients, predictors of mortality are the severity of the pelvic fracture, the presence of coma, shock, and head and chest injuries.

Grotz MRW, Allami MK, Harwood P et al (2005) Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury 36:1–13PubMedCrossRef

Durkin A, Sagi HC, Durham R et al (2006) Contemporary management of pelvic fractures. Am J Surg 192:211–223PubMedCrossRef

Cothren CC, Osborn PM, Moore EE et al (2007) Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift. J Trauma 62:834–839, discussion 839-842PubMedCrossRef

Brenneman FD, Katyal D, Boulanger BR et al (1997) Long-term outcomes in open pelvic fractures. J Trauma 42:773–777PubMedCrossRef

Madhu TS, Raman R, Giannoudis PV (2007) Long-term outcome in patients with combined spinal and pelvic fractures. Injury 38:598–606PubMedCrossRef

Poole GV, Ward EF, Muakkassa FF et al (1991) Pelvic fracture from major blunt trauma. Outcome is determined by associated injuries. Ann Surg 213:532–538, discussion 538-539PubMedPubMedCentralCrossRef

Poole GV, Ward EF (1994) Causes of mortality in patients with pelvic fractures. Orthopedics 17:691–696PubMed

Henry SM, Pollak AN, Jones AL et al (2002) Pelvic fracture in geriatric patients: a distinct clinical entity. J Trauma 53:15–20PubMedCrossRef

Deakin DE, Boulton C, Moran CG (2007) Mortality and causes of death among patients with isolated limb and pelvic fractures. Injury 38:312–317PubMedCrossRef

10.

American College of Surgeons Committee on Trauma (2004) Advanced Trauma Life Support for Doctors (ATLS).

11.

Gustavo Parreira J, Coimbra R, Rasslan S et al (2000) The role of associated injuries on outcome of blunt trauma patients sustaining pelvic fractures. Injury 31:677–682PubMedCrossRef

12.

White CE, Hsu JR, Holcomb JB (2009) Haemodynamically unstable pelvic fractures. Injury 40:1023–1030PubMedCrossRef

13.

Dente CJ, Feliciano DV, Rozycki GS et al (2005) The outcome of open pelvic fractures in the modern era. Am J Surg 190:830–835PubMedCrossRef

14.

Per L, Al-Haji G (2005) Road safety in southeast Asia: Factors affecting motorcycle safety. Available via ICTCT. http://www.ictct.org/dlObject.php?document_nr=93&/S2_Lindskog_Al-Haji.pdf. Accessed 19 Feb 2010.

15.

Starr AJ, Griffin DR, Reinert CM et al (2002) Pelvic ring disruptions: prediction of associated injuries, transfusion requirement, pelvic arteriography, complications, and mortality. J Orthop Trauma 16:553–561PubMedCrossRef

16.

Hanson PB, Milne JC, Chapman MW (1991) Open fractures of the pelvis. Review of 43 cases. J Bone Joint Surg Br 73:325–329PubMed

17.

Brainard BJ, Slauterbeck J, Benjamin JB (1992) Fracture patterns and mechanisms in pedestrian motor-vehicle trauma: the ipsilateral dyad. J Orthop Trauma 6:279–282PubMedCrossRef

18.

Adams JE, Davis GG, Alexander CB et al (2003) Pelvic trauma in rapidly fatal motor vehicle accidents. J Orthop Trauma 17:406–410PubMedCrossRef

19.

Scalea T, Goldstein A, Phillips T et al (1986) An analysis of 161 falls from a height: the 'jumper syndrome'. J Trauma 26:706–712PubMedCrossRef

20.

Agalar F, Cakmakci M, Sayek I (1999) Factors effecting mortality in urban vertical free falls: evaluation of 180 cases. Int Surg 84:271–274PubMed

21.

Demetriades D, Murray J, Brown C et al (2005) High-level falls: type and severity of injuries and survival outcome according to age. J Trauma 58:342–345PubMedCrossRef

22.

Fang J-F, Shih L-Y, Lin B-C et al (2008) Pelvic fractures due to falls from a height in people with mental disorders. Injury 39:881–888PubMedCrossRef

23.

Chong KH, DeCoster T, Osler T et al (1997) Pelvic fractures and mortality. Iowa Orthop J 17:110–114PubMedPubMedCentral

24.

Stein DM, O'Connor JV, Kufera JA et al (2006) Risk factors associated with pelvic fractures sustained in motor vehicle collisions involving newer vehicles. J Trauma 61:21–30, discussion 30-21PubMedCrossRef

25.

O'Sullivan REM, White TO, Keating JF (2005) Major pelvic fractures: identification of patients at high risk. J Bone Joint Surg Br 87:530–533PubMedCrossRef

26.

Kido A, Inoue F, Takakura Y et al (2008) Statistical analysis of fatal bleeding pelvic fracture patients with severe associated injuries. J Orthop Sci 13:21–24PubMedCrossRef

27.

Lee C, Porter K (2007) The prehospital management of pelvic fractures. Emerg Med J 24:130–133PubMedPubMedCentralCrossRef

28.

O'Brien DP, Luchette FA, Pereira SJ et al (2002) Pelvic fracture in the elderly is associated with increased mortality. Surgery 132:710–714PubMedCrossRef

29.

Dechert TA, Duane TM, Frykberg BP et al (2009) Elderly patients with pelvic fracture: interventions and outcomes. Am Surg 75:291–295PubMed

30.

Alost T, Waldrop RD (1997) Profile of geriatric pelvic fractures presenting to the emergency department. Am J Emerg Med 15:576–578PubMedCrossRef

Title: Patients with pelvic fracture: what factors are associated with mortality?
Authors: Chee Kheong Ooi
Hsin K. Goh
Seow Y. Tay
Dong H. Phua
Publication date: 01-12-2010
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Emergency Medicine / Issue 4/2010
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI: https://doi.org/10.1007/s12245-010-0224-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Patients with pelvic fracture: what factors are associated with mortality?

Abstract

Background

Aims

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Aims

Methods

Results

Conclusions

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