BACKGROUND: Bleeding pelvic fracture patients with severe associated injuries have a high mortality rate that is exacerbated by several factors. To gain deeper etiological insights into this injury, we investigated the specific risk factors associated with the high mortality rate. METHODS: A total of 102 bleeding pelvic fracture patients with severe associated injuries (abbreviated injury score > or =3) were treated at our level I trauma center between January 1994 and December 2004. Predictors of death within 24 h of arrival were determined by univariate and multivariate analyses using anatomic and physiologic parameters, including injured body part, shock symptoms, age, sex, injury severity score (ISS), and fracture type. RESULTS: Overall, 47 of the 102 patients died within 24 h of arrival. Hemorrhage shock was responsible for the majority of deaths (47%). Other causes included central nervous system injury (21%), multiple injuries (central nervous system injury plus shock, 18%) and multiple organ failures (7%). Univariate analyses revealed that patients presenting with head and neck injuries and shock symptoms on arrival were associated with an increased risk of death (P < 0.01 for both variables). Multivariate analyses revealed that these injuries and shock symptoms were independently associated with a higher risk of death (odds ratios of 2.704 and 4.632, respectively). The mechanism of injury, fracture type, age, sex, and ISS were not associated with an increased risk of death. CONCLUSIONS: Statistically significant risk factors were brain injuries and shock symptoms on arrival. Brain injuries should be heavily weighted when evaluating the prognosis of bleeding pelvic fracture patients.
BACKGROUND:Bleeding pelvic fracturepatients with severe associated injuries have a high mortality rate that is exacerbated by several factors. To gain deeper etiological insights into this injury, we investigated the specific risk factors associated with the high mortality rate. METHODS: A total of 102 bleeding pelvic fracturepatients with severe associated injuries (abbreviated injury score > or =3) were treated at our level I trauma center between January 1994 and December 2004. Predictors of death within 24 h of arrival were determined by univariate and multivariate analyses using anatomic and physiologic parameters, including injured body part, shock symptoms, age, sex, injury severity score (ISS), and fracture type. RESULTS: Overall, 47 of the 102 patients died within 24 h of arrival. Hemorrhage shock was responsible for the majority of deaths (47%). Other causes included central nervous system injury (21%), multiple injuries (central nervous system injury plus shock, 18%) and multiple organ failures (7%). Univariate analyses revealed that patients presenting with head and neck injuries and shock symptoms on arrival were associated with an increased risk of death (P < 0.01 for both variables). Multivariate analyses revealed that these injuries and shock symptoms were independently associated with a higher risk of death (odds ratios of 2.704 and 4.632, respectively). The mechanism of injury, fracture type, age, sex, and ISS were not associated with an increased risk of death. CONCLUSIONS: Statistically significant risk factors were brain injuries and shock symptoms on arrival. Brain injuries should be heavily weighted when evaluating the prognosis of bleeding pelvic fracturepatients.
Authors: Markus Burkhardt; Ulrike Nienaber; Antonius Pizanis; Marc Maegele; Ulf Culemann; Bertil Bouillon; Sascha Flohé; Tim Pohlemann; Thomas Paffrath Journal: Crit Care Date: 2012-08-22 Impact factor: 9.097