Mina Cheng1, Kin-Yan Lee2, Annice-M L Chang3, Hiu-Fai Ho3, Lily-P S Chan3, Kin-Bong Lee4, Philip-C H Kwok5, Alexander-C W Lee5, Kevin-Y K Wong5, Chak-Wah Kam6, Gilberto-K K Leung7, John-K S Wong6, Nai-Kwong Cheung8, Janice-H H Yeung8, Ning Tang9, Shing-Hing Choi10, Tak-Wing Lau11, Heidi-H T Wong12, Ming Leung13. 1. Department of Surgery, Queen Elizabeth Hospital, 33 Gascoigne Road, Kowloon, Hong Kong. minacheng0505@gmail.com. 2. Department of Surgery, Queen Elizabeth Hospital, 33 Gascoigne Road, Kowloon, Hong Kong. 3. Department of Accident and Emergency, Queen Elizabeth Hospital, 33 Gascoigne Road, Kowloon, Hong Kong. 4. Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, 33 Gascoigne Road, Kowloon, Hong Kong. 5. Department of Radiology and Imaging, Queen Elizabeth Hospital, 33 Gascoigne Road, Kowloon, Hong Kong. 6. Department of Accident and Emergency, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong. 7. Department of Surgery, Queen Mary Hospital, 102 Pokfulam Road, Pok Fu Lam, Hong Kong. 8. Department of Accident and Emergency, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong. 9. Department of Orthopaedics and Traumatology, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong. 10. Department of Orthopaedics and Traumatology, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong. 11. Department of Orthopaedics and Traumatology, Queen Mary Hospital, 102 Pokfulam Road, Pok Fu Lam, Hong Kong. 12. Department of Accident and Emergency, Queen Mary Hospital, 102 Pokfulam Road, Pok Fu Lam, Hong Kong. 13. Department of Accident and Emergency, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong.
Abstract
PURPOSE: The mortality rate in patients with haemodynamically unstable pelvic fractures is as high as 40-60%. Despite the new advances in trauma care which are in phase in trauma centres in Hong Kong, the management of haemodynamically unstable pelvic fracture is still heterogeneous. The aim of this study is to review the results of management of haemodynamically unstable pelvic fracture patients in Hong Kong over a five year period. METHODS: This is a retrospective multi-centred cohort study of patients with haemodynamic and mechanically unstable pelvic fractures from 1 January 2010 to 31 December 2014. The primary outcome investigated is mortality of patients (including overall, 30-day, 7-day and 24-hour mortalities). RESULTS: Implementation of three-in-one pelvic damage control protocol was identified to be a significant independent predictive factor for overall, 30-day, seven-day and 24-hour mortalities. The overall in-hospital and 30-day mortality rates for patients managed with three-in-one protocol was 12.5%, while it was 11% for seven day mortality and 6% for 24 hour mortality. There were no significant differences in demographic characteristics, physiological measurements, types of pelvic fracture, severity and mechanism of injury between patients managed with or without three-in-one protocol. CONCLUSIONS: Implementation of the multidisciplinary three-in-one pelvic damage control protocol reduces mortality and therefore should be highly recommended. The results are convincing as it has eliminated the limitations of our previous single-centred trial.
PURPOSE: The mortality rate in patients with haemodynamically unstable pelvic fractures is as high as 40-60%. Despite the new advances in trauma care which are in phase in trauma centres in Hong Kong, the management of haemodynamically unstable pelvic fracture is still heterogeneous. The aim of this study is to review the results of management of haemodynamically unstable pelvic fracturepatients in Hong Kong over a five year period. METHODS: This is a retrospective multi-centred cohort study of patients with haemodynamic and mechanically unstable pelvic fractures from 1 January 2010 to 31 December 2014. The primary outcome investigated is mortality of patients (including overall, 30-day, 7-day and 24-hour mortalities). RESULTS: Implementation of three-in-one pelvic damage control protocol was identified to be a significant independent predictive factor for overall, 30-day, seven-day and 24-hour mortalities. The overall in-hospital and 30-day mortality rates for patients managed with three-in-one protocol was 12.5%, while it was 11% for seven day mortality and 6% for 24 hour mortality. There were no significant differences in demographic characteristics, physiological measurements, types of pelvic fracture, severity and mechanism of injury between patients managed with or without three-in-one protocol. CONCLUSIONS: Implementation of the multidisciplinary three-in-one pelvic damage control protocol reduces mortality and therefore should be highly recommended. The results are convincing as it has eliminated the limitations of our previous single-centred trial.
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