Management and outcomes of severe pelvic fractures in level I and II ACS verified trauma centers

• Published in: The American journal of surgery Vol. 222; no. 1; pp. 227 - 233
• Main Authors: Jakob, Dominik A., Benjamin, Elizabeth R., Cremonini, Camilla, Demetriades, Demetrios
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 01.07.2021; Elsevier Limited
• Subjects: Angiography; Blood products; Blood transfusion; Cardiac arrhythmia; Complications; Disease prevention; Facility level; Fractures; Hospitals; Hypotension; Injuries; Intensive care; Laparotomy; Medical imaging; Mortality; Multivariate analysis; Outcome; Patients; Pelvic fracture; Pharmacology; Pneumonia; Prophylaxis; Quality control; Thromboembolism; Transfusion; Trauma; Trauma centers; United States > US; Facility level; Pelvic fracture; Angiography; Outcome
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2020.10.031

The aim of this study was to evaluate the management strategies and outcomes of isolated severe pelvic fractures in level I and II ACS verified trauma centers. ACS-TQIP database study, including patients with blunt, isolated severe pelvic facture (AIS 3–5). 2629 level I and 1277 level II patients were included. Early blood product transfusion was significantly higher, pharmacological VTE prophylaxis significantly lower and ICU length of stay significantly longer in level II centers (p < 0.001). On multivariate analysis, treatment at level II centers was independently associated with increased overall complications, specifically ARDS, but not mortality. In isolated severe pelvic fractures there was a significantly higher use of early blood products, less VTE pharmacological prophylaxis, longer ICU length of stay and higher overall complications and ARDS in level II centers. Blood product utilization and pharmacological VTE prophylaxis are potential areas of quality improvement in level II centers. •Higher overall complications in level II centers in isolated severe pelvic fractures.•Significantly higher use of early blood product in level II centers.•More consequent use of LMWH as VTE prophylaxis in level I centers.•Blood product use and VTE prophylaxis as potential areas of quality improvement in level II centers.