Dayley S Keil1, Steven Gross2, Rachel B Seymour3, Stephen Sims3, Madhav A Karunakar3. 1. University of North Carolina School of Medicine, Chapel Hill, NC. 2. Illinois Bone & Joint Institute, Barrington, IL. 3. Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC.
Abstract
OBJECTIVES: To document in-hospital and 1-year mortality rates after high-energy pelvic fracture in patients 65 years of age or older as compared to a younger cohort. DESIGN: Retrospective review. SETTING: Urban Level 1 academic trauma center. PATIENTS: Seventy consecutive patients 65 years of age and older treated for pelvic fracture resulting from high-energy mechanism from 2008 to 2011. A total of 140 patients 18-64 years of age were matched to the study population based on mechanism of injury and OTA Code 61 subtype for comparison. INTERVENTION: Review of demographics, injury characteristics, hospital management, and mortality. MAIN OUTCOME MEASUREMENTS: Mortality. RESULTS: The overall inpatient mortality rate was 10%. The older cohort exhibited an inpatient mortality rate 3 times higher than the younger cohort (18.6% vs. 5.7%, P = 0.003). There was no difference in mortality 1 year post discharge (5.3% vs. 3.8%, P = 0.699). No significant differences in initial Glasgow Coma Scale or Injury Severity Score were identified (GCS 12.9 vs. 12.4, P = 0.363; ISS 24.7 vs. 23.4, P = 0.479). Multivariate analysis identified the Charlson Comorbidity Index (CCI) (P = 0.012) and Abbreviated Injury Scale (AIS)-chest (P = 0.005) as independent predictors of in-hospital mortality, and CCI (0.005) and AIS-abdomen (0.012) for 1-year mortality. CONCLUSIONS: After controlling for mechanism of injury and pelvic fracture classification, we found that adults ≥65 and those with multiple comorbidities were more likely to die in the hospital than younger adults. However, mortality within 1-year postdischarge was low and did not differ between groups. This is in sharp contrast to the high rates of postdischarge mortality observed in elderly patients with a hip fracture. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVES: To document in-hospital and 1-year mortality rates after high-energy pelvic fracture in patients 65 years of age or older as compared to a younger cohort. DESIGN: Retrospective review. SETTING: Urban Level 1 academic trauma center. PATIENTS: Seventy consecutive patients 65 years of age and older treated for pelvic fracture resulting from high-energy mechanism from 2008 to 2011. A total of 140 patients 18-64 years of age were matched to the study population based on mechanism of injury and OTA Code 61 subtype for comparison. INTERVENTION: Review of demographics, injury characteristics, hospital management, and mortality. MAIN OUTCOME MEASUREMENTS: Mortality. RESULTS: The overall inpatient mortality rate was 10%. The older cohort exhibited an inpatient mortality rate 3 times higher than the younger cohort (18.6% vs. 5.7%, P = 0.003). There was no difference in mortality 1 year post discharge (5.3% vs. 3.8%, P = 0.699). No significant differences in initial Glasgow Coma Scale or Injury Severity Score were identified (GCS 12.9 vs. 12.4, P = 0.363; ISS 24.7 vs. 23.4, P = 0.479). Multivariate analysis identified the Charlson Comorbidity Index (CCI) (P = 0.012) and Abbreviated Injury Scale (AIS)-chest (P = 0.005) as independent predictors of in-hospital mortality, and CCI (0.005) and AIS-abdomen (0.012) for 1-year mortality. CONCLUSIONS: After controlling for mechanism of injury and pelvic fracture classification, we found that adults ≥65 and those with multiple comorbidities were more likely to die in the hospital than younger adults. However, mortality within 1-year postdischarge was low and did not differ between groups. This is in sharp contrast to the high rates of postdischarge mortality observed in elderly patients with a hip fracture. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Authors: Andreas Höch; Philipp Pieroh; Florian Gras; Tim Hohmann; Sven Märdian; Francis Holmenschlager; Holger Keil; Hans-Georg Palm; Steven C Herath; Christoph Josten; Hagen Schmal; Fabian M Stuby Journal: Int Orthop Date: 2019-04-04 Impact factor: 3.075
Authors: Jianqiu Xiao; Chun Wang; Juo-Chin Yao; Yael Alippe; Tong Yang; Dustin Kress; Kai Sun; Kourtney L Kostecki; Joseph B Monahan; Deborah J Veis; Yousef Abu-Amer; Daniel C Link; Gabriel Mbalaviele Journal: PLoS Biol Date: 2020-08-06 Impact factor: 8.029