Impact of pelvic fractures on the early clinical outcomes of severely injured trauma patients

• Published in: European journal of trauma and emergency surgery (Munich : 2007) Vol. 44; no. 2; pp. 155 - 162
• Main Authors: Almahmoud, K., Pfeifer, R., Al-Kofahi, K., Hmedat, A., Hyderabad, W., Hildebrand, F., Peitzman, A. B., Pape, H.-C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2018; Springer Nature B.V
• Subjects: Adult; Age; Case-Control Studies; Clinical outcomes; Cohort Studies; Critical Care Medicine; Emergency Medicine; Female; Fractures; Fractures, Bone - mortality; Germany; Humans; Injury Severity Score; Intensive; Length of Stay; Male; Medicine; Medicine & Public Health; Multiple Trauma - mortality; Original Article; Pelvic Bones - injuries; Quantitative analysis; Retrospective Studies; Sports Medicine; Surgery; Surgical Orthopedics; Trauma; Traumatic Surgery; Clinical parameters; Pelvic fracture; Trauma; Injury; Clinical outcomes; Damage control
• ISSN: 1863-9933; 1863-9941
• DOI: 10.1007/s00068-016-0754-6

Background Pelvic fractures contribute to morbidity and mortality following injury. We sought to study the impact of pelvic fractures on the clinical course and outcomes of trauma patients with a pelvic fracture in comparison to patients with similar injury severity without pelvic fracture to identify potential parameters to track patients’ clinical course post-injury. Methods A cohort of 206 consecutive blunt trauma survivors, studied over a 5-year period in a level I trauma center of which 75 patients (36.4%) had a pelvic fracture, was included in the study. To perform a retrospective cohort study with matched controls, 60 patients of the pelvic fracture group [(PF), 41 males and 19 females; age: 40 ± 17; injury severity score (ISS): 26.6 ± 9.3] were compared to 60 patients without pelvic fracture (non-PF) trauma as controls (41 males and 19 females; age: 40 ± 13; ISS: 26.9 ± 7.7), both with matching age (±5 years), sex, and ISS (±5 points). Results Statistically significant differences were observed in Intensive Care Unit (ICU) length of stay (LOS), total LOS, and Marshall MOD score between PF and non-PF groups, respectively. Acid–base markers such as pH, lactate, LDH, and base deficit were all significantly altered in PF compared to non-PF cohort upon admission. Moreover, our analysis showed significant differences in inflammatory biomarkers (Prolactin, CRP, and IL-6), and clinical parameters (CPK, Hgb, Platelets count, and WBC) over the 7-day clinical course in patients with PF when compared to non-PF cohort. Conclusion In this matched cohort, patients with pelvic fractures exhibited biochemical and physiological alterations upon admission. Furthermore, our results suggest that pelvic fracture affects the clinical outcomes in severely injured patients, independently of injury severity, mechanism of injury, age or gender.