Patients with pelvic fractures from blunt trauma. What is the cause of mortality and when?

• Published in: The American journal of surgery 2016-03, Vol.211 (3), p.495-500
• Main Authors: Vaidya, Rahul, M.D., F.R.C.Sc, Scott, Alesha N., D.O, Tonnos, Fred, D.O, Hudson, Ian, D.O., M.P.H, Martin, Adam J., B.S, Sethi, Anil, M.D
• Format: Article
• Language: English
• Subjects: Abdomen; Adolescent; Adult; Age; Aged; Aged, 80 and over; Blood products; Blood transfusions; Bone surgery; Cause of Death; Classification; Female; Fractures, Bone - etiology; Fractures, Bone - mortality; Fractures, Bone - therapy; Head injuries; Humans; Injury Severity Score; Intensive care; Male; Methods; Middle Aged; Mortality; Pelvic Bones - injuries; Pelvic fracture; Respiratory distress syndrome; Risk Factors; Studies; Surgery; Survival Rate; Survival time; Trauma; Trauma centers; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - mortality; Wounds, Nonpenetrating - therapy
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2015.08.038

Abstract Background Mortality in patients sustaining pelvic fractures has been reported to be 4% to 15%. We sought to investigate the cause of death based on timing and evaluate if type of fracture and Injury Severity Score have an influence on the survival time. Methods Sixty-nine patients of eight hundred sixty seven with a pelvic fracture who died during their hospital admission were included. Fractures were classified using the Arbeitsgemeinschaft Osteosynthesefragen/Orthopaedic Trauma Association system. Cause determined by autopsy in 48/69. Results The leading cause of death within 6 hours was abdominal and pelvic hemorrhage; 6 to 24 hours head injury, and greater than 24 hours multiple organ dysfunction syndrome. Survival time did not correlate between fracture type ( P < .12) or Injury Severity Score. Only 2 patients died of isolated pelvic hemorrhage. Conclusions Despite the advances made in acute management of the traumatized patient in the emergency department, mortality is unavoidable in a small group of patients with hemorrhage being the commonest cause of early death but isolated pelvic hemorrhage rare.