Mortality in patients with pelvic fractures: results from the German pelvic injury register.

BACKGROUND: Pelvic and acetabular fractures are rare injuries and account for approximately 3% to 8% of all fractures. Often the result of high energy blunt trauma, most of the patients sustaining pelvic injuries are at high risk of associated injuries strongly influencing outcome and survival rates. Because of anatomic differences it has been suggested that pediatric pelvic fractures are different injuries as compared with that of adults. However, this has been controversially discussed. Aim of this multicenter register study was to identify similarities and differences between pediatric and adult pelvic trauma and evaluate the influence of changes in medical treatment by comparison of two treatment periods.
METHODS: In this multicenter register study, data of 4,291 patients treated from 1991 to 1993 (n = 1,723) or 1998 to 2000 (n = 2,568) for pelvic fractures in one of the 23 participating hospitals were evaluated for age, gender, Injury Severity Score (ISS), Hannover Polytrauma Score (PTS), fracture type (using Tile's classification), peripelvic soft tissue injury, need for emergency measures, mortality, cause of death, and need for operative stabilization. We compared the patients' characteristics of the two treatment periods and pediatric with adult pelvic injuries. Statistical analysis was performed using SAS software.
RESULTS: There was no difference in terms of ISS, PTS, and presence of peripelvic soft tissue injuries between the two observation periods. Mortality rate dropped significantly from 7.9% to 5% (p < 0.0001) in the latter treatment period. Death was directly attributed to the pelvic injury in 11% from 1991 to 1993. This rate dropped significantly to 7% in the period from 1998 to 2000 (p = 0.020). A type fractures decreased from 61.1% (1991-1993) to 57.1% (1998-2000) of patients (p = 0.028) and except for these simple fractures there was a significant overall trend toward surgical treatment. Multivariate analysis revealed ISS, PTS, concomitant soft tissue injuries, and need for emergency measures as independent risk factors for death whereas surgical stabilization and treatment in the latter treatment period were associated with an increased survival rate. We found no difference between the adult and the pediatric group in terms of ISS and concomitant peripelvic soft tissue injuries. Children were less likely to receive surgical treatment (19.4% vs. 34.5%, p < 0.0001) but requirement for emergency measures was higher in the pediatric group (17.9% vs. 11.1%, p = 0.033). Moreover, we found no significant differences in mortality between both groups (6.1% vs. 8.2%, p = 0.28). Multivariate analysis showed age </=15 years was not an independent risk factor for death.
CONCLUSION: The survival rate of patients sustaining pelvic fracture has improved significantly within the last decade. Most deaths in patients with pelvic fractures are not caused by the pelvic fracture itself but are linked to associated injuries. Despite anatomic and epidemiologic differences there are significant similarities between pediatric and adult patients with pelvic injuries and the mortality rate of children is not different from that of adults.