J Korean Soc Emerg Med.  2009 Jun;20(3):280-287.

Predictors of Mortality in Hemodynamically Unstable Traumatic Patients with Pelvic Fracture

Affiliations
  • 1Department of Emergency Medicine, School of Medicine, Chonnam National University, Gwangju, Korea. bbukkuk@hanmail.net

Abstract

PURPOSE: Pelvic fracture is one of the more serious skeletal injuries, resulting in substantial mortality. The large amount of kinetic energy necessary to fracture the bony pelvis often leads to concomitant thoraco-abdominal injury. Pelvic fracture and combined injuries need effective initial resuscitation. However, it is hard to predict mortality due to the complexity of multiple injuries. Therefore, the purpose of this study was to identify factors predicting mortality in patients with pelvic fracture and concomitant thoraco-abdominal injury.
METHODS
A retrospective study was performed on 174 cases of pelvic fracture who visited the Emergency Department between January 2003 and June 2008. Data were collected regarding demographic characteristics, mechanism of injury, injury severity score (ISS), Abbreviated Injury Score (AIS), Simplified Acute Physiologic Score II (SAPS II), transfusion requirements, fluid requirements, the findings on angiography, hemoglobin level, platelet count, prothrombin time (PT), fibrinogen, albumin, base deficit, lactate, anti-thrombin III, length of ICU stay, and total hospitalization days. Pelvic fracture categories were derived by adapting the Young-Burgess classification.
RESULTS
One hundred forty patients survived (Group I); 34 died (Group II). Blood pressure, pulse rate, hemoglobin, albumin, lactate, base deficit, PT, fibrinogen and Antithrombin III were significantly different between two groups. Transfusion, fluid requirements, ISS and SAPS II were significantly higher in group II. Extravasation on the CT was more frequent found in group II. The ISS 1.194 (95% CI, 1.076~1.325) and SAPS II 1.162 (95% CI,1.042~1.296) were independent significant predictors of mortality.
CONCLUSION
Predictors of mortality in pelvic fracture patients should be available during the first attempt at resuscitation. The ISS and SAPS II were the most important predictors in defining mortality.

Keyword

Pelvic bones; Multiple Trauma; Mortality; Prognosis

MeSH Terms

Angiography
Antithrombin III
Blood Pressure
Emergencies
Fibrinogen
Heart Rate
Hemoglobins
Hospitalization
Humans
Injury Severity Score
Lactic Acid
Multiple Trauma
Pelvic Bones
Pelvis
Platelet Count
Prognosis
Prothrombin Time
Resuscitation
Retrospective Studies
Antithrombin III
Fibrinogen
Hemoglobins
Lactic Acid
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