Abstract
BackgroundEvaluation of the pelvic fractures (PFx) population in auditing effective components of trauma care is the subject of this study.MethodsA retrospective, case-control, autopsy-based study compared a population with PFx to a control-group using a template with trauma outcome variables, which included demographics, ICD-9, intention, mechanisms, toxicology, Abbreviated Injury Scale (AIS-90), Injury Severity Score (ISS), causes of haemorrhage, comorbidity, survival time, pre-hospital response, in hospital data, location of death, and preventable deaths.ResultsOf 970 consecutive patients with fatal falls, 209 (21.5%) had PFx and constituted the PFx-group while 761 (78.5%) formed the control-group.Multivariate analysis showed that gender, age, intention, and height of fall were risk factors for PFx. A 300% higher odds of a psychiatric history was found in the PFx-group compared to the control-group (p < 0.001).The median ISS was 50 (17-75) for the PFx-group and 26 (1-75) for the control-group (p < 0.0001). There were no patients with an ISS less than 16 in the PFx group.Associated injuries were significantly more common in the PFx-group than in the control-group. Potentially preventable deaths (ISS < 75) constituted 78% (n = 163) of the PFx-group. The most common AIS3-5 injuries in the potentially preventable subset of patients were the lower extremities in 133 (81.6%), thorax in 130 (79.7%), abdomen/pelvic contents in 99 (60.7%), head in 95 (58.3%) and the spine in 26 (15.9%) patients.A subset of 126 (60.3%) potentially preventable deaths in the PFx-group had at least one AIS-90 code other than the PFx, denoting major haemorrhage. Deaths directly attributed to PFx were limited to 6 (2.9%).The median survival time was 30 minutes for the PFx-group and 20 hours for the control-group (p < 0.001). For a one-group increment in the ISS-groups, the survival rates over the post-traumatic time intervals were reduced by 57% (p < 0.0001).Pre-hospital mortality was significantly higher in the PFx-group i.e. 70.3% of the PFx-group versus 42.7% of the control-group (p < 0.001).ConclusionsThe PFx-group shared common causative risk factors, high severity and multiplicity of injuries that define the PFx-group as a paradigm of injury for audit. This reduced sample of autopsies substantially contributed to the audit of functional, infrastructural, management and prevention issues requiring transformation to reduce mortality.
Highlights
Evaluation of the pelvic fractures (PFx) population in auditing effective components of trauma care is the subject of this study
The Pelvic fracture (PFx) group represented 4.2% of the total 5,007 allcauses trauma fatalities excluding those that were due to drowning and poisoning, who were subjected to formal autopsy during the study period
PFx was taken as the dependent variable and gender, age, intention for injury, and height of fall as the independent variables
Summary
Evaluation of the pelvic fractures (PFx) population in auditing effective components of trauma care is the subject of this study. An evidence based transformation of trauma care is nowadays necessary. Based trauma databanks and prospective research have substantially contributed to this task. Autopsy based audit remains a useful option, but selecting the trauma population in order to audit trauma care is an essential issue. In a recent publication [2], PFx related fatalities were used as a basis to audit the trauma care system in Greece. The rational and the theoretical basis of selecting PFx to audit trauma care is that the pelvis is an inherently stable structure, large energy absorption is required to produce a PFx. Energy dissipation causes many life threatening associated injuries. Selecting the population with PFx should select a reproducible population, allowing data comparison
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