Abstract
BackgroundRisks of predicting time-related in-hospital mortality varies in pelvic trauma patients. We aim to identify potential independent risks predictive of time-related (early versus late) mortality among pelvic trauma patients.MethodsLocal trauma registry data from 2004 through 2013 were reviewed. Mortality causes and timing of death were investigated. Multivariate logistic regression identified independent risks predictive of early versus late mortality in pelvic trauma patients while adjusting for patient demographics (age, sex, race), clinical variables (initial vital signs, mental status, injury severity, associated injuries, comorbidities), and hospital outcomes (surgical interventions, crystalloid resuscitations, blood transfusions).ResultsWe retrospectively collected data on 1566 pelvic trauma patients with a mortality rate of 9.96 % (156/1566). Approximately 74 % of patients died from massive hemorrhage within the first 24 h of hospitalization (early mortality). Revised trauma score (RTS), injury severity score (ISS), initial hemoglobin, direct transfer to operating room, and blood transfusion administration in the Emergency Department were considered independent risk factors predictive of early mortality. Age, ISS, and Glasgow Coma Scale (GCS) were deemed risk factors predictive of death after 24 h (late mortality).DiscussionGiven the fact of a substantial number of patients died within the first 24 h of hospital arrival, it is reasonable to consider the first 24 h of hospitalization as the appropriate window within which early mortality may be expected to occur in pelvic trauma patients. The risk factors associated with massive hemorrhage were strong predictors of early mortality, whereas late mortality predictors were more closely linked with comorbidities or in-hospital complications.ConclusionsWhile risk factors predictive of early versus late mortality vary, ISS seems to predict both early and late mortality accurately in pelvic trauma patients.
Highlights
Risks of predicting time-related in-hospital mortality varies in pelvic trauma patients
Chong et al [10] reported the majority of pelvic trauma patients whose deaths occurred within the first 72 h were due to pelvic hemorrhage, non-pelvic injury, or brain trauma, while those deaths occurring later (>72 h) were attributed to multisystem organ failure or acute respiratory distress syndrome (ARDS)
Other tools have determined different values of predicting time-related mortality in pelvic trauma with either Revised trauma score (RTS) or injury severity score (ISS) [12, 22, 23]. Though these studies reported the value of incorporating RTS and ISS in the prediction of early versus late hospital mortality their definitions of early mortality were different from other studies [19, 24]
Summary
Risks of predicting time-related in-hospital mortality varies in pelvic trauma patients. We aim to identify potential independent risks predictive of time-related (early versus late) mortality among pelvic trauma patients. Different independent risk factors predictive of in-hospital mortality in pelvic trauma have been reported. Results from a United Kingdom pelvic trauma registry study showed that patient age, initial blood pressure, mental status, injury severity score, and other associated injuries were independent risk factors for mortality [4]. Other tools have determined different values of predicting time-related mortality in pelvic trauma with either RTS or ISS [12, 22, 23]. Since in-hospital mortality predictors among pelvic trauma patients varies especially in the prediction of time-related mortality, it is important to differentiate early versus late in-hospital mortality, delineate its etiologies, and identify its appropriate predictors associated with time
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