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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2013 February;64(1):53-61
Pelvic injuries: incidence and associated emergency room mortality in a high volume trauma center
Doll D. 1, 5, Matevossian E. 2, Suda A. J. 3, Stettbacher A. 4, Degiannis E. 1 ✉
1 Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa;
2 Department of Surgery, Klinikum rechts der Isar, Munich, Germany;
3 BG Trauma Center Ludwigshafen, Ludwigshafen, Germany;
4 Surgeon General of the Swiss Armed Forces, Ittigen, Switzerland;
5 Department of Visceral, Thoracic and Vascular Surgery, Philipps University, Marburg, Germany
Aim: Pelvic injuries are associated with considerable mortality. The aim of the study was to determine incidence and emergency room mortality for blunt and penetrating pelvic injuries in a single institution.
Methods: Retrospective analysis of 12 month emergency room (ER) charts identifying injury mechanism, injured area(s), hemodynamic and clinical parameters.
Results: The emergency room incidence of pelvic injuries is 5.5% (157/2857 patients) with penetrating pelvic (109/2857, 3.8%) outweighing blunt pelvic injuries (47/2857, 1.6%). ER mortality of penetrating pelvic injuries is 1/109 (1%) comparing to 7/47 (15%) in blunt pelvic injuries. Pelvic ER mortality (5.1%) exceeds average ER mortality (4.2%), only topped by single head injury mortality (7.3%). Factors associated with increased mortality are unconsciousness (OR=69, P<0.0001; all OR: Fisher test), intubation (OR=82, P<0.0001), blunt injury in contrast to penetrating injury (OR=16, P=0.002), pelvic fracture (OR=9, P=0.006) and systolic blood pressure lower than 100 on admission (OR: ∞; P=0.0002).
Conclusion: ER demise after pelvic injury is twice as late compared to other injury deaths. Concomitant injuries, especially head injuries, increase to this death toll. Pelvic injuries present with lower BP and higher shock index than comparable injuries to other body regions. Consecutive Emergency Room mortality is higher especially if admission BP is below 100 mmHg. Aggressive resuscitation and fast transfer to theatre in case of suspected vessel injury and early temporary pelvic stabilisation in case of instable pelvic fracture for hemorrhage control are crucial to improve patient survival.