Predictors of Acute Mortality After Open Pelvic Fracture: Experience From 37 Patients From A Level I Trauma Center
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ORIGINAL SCIENTIFIC REPORT
Predictors of Acute Mortality After Open Pelvic Fracture: Experience From 37 Patients From A Level I Trauma Center I-Chuan Tseng1 • I-Jung Chen1 • Ying-Chao Chou1 • Yung-Heng Hsu1 • Yi-Hsun Yu1
Accepted: 21 June 2020 Ó The Author(s) 2020
Abstract Background Open pelvic fractures are caused by high-energy traumas and are accompanied by organ injuries. Despite improvements in pre-hospital care, the acute mortality rate following open pelvic fractures remains high. This study aimed to report experiences in managing open pelvic fractures, identify potential independent predictors that contribute to acute mortality in such patients, and generate a scoring formula to predict mortality rate. Methods Open pelvic fracture patients managed during a 42-month period were retrospectively studied. Logistic regression analysis was used to determine predictors of acute mortality. Using the Youden index, threshold values of predictors were selected. Significant predictors were weighted to create a scoring formula. The area under the curve (AUC) was tested in this specific group. Results The incidence of open pelvic fractures in all pelvic fractures was 4.9% (37/772), and the overall mortality rate was 21.6% (8/37). All the successfully resuscitated patients entered the reconstruction stage survived and underwent the complete treatment course. Univariate and multivariate logistic regression analyses revealed that the revised trauma score (RTS) was the single independent predictor of acute mortality. A scoring formula was generated following the statistical analysis. The probability of mortality was 0% and 100% when the score was above and below -2, respectively. This model predicted mortality with an AUC of 0.948 (95% confidence interval 0.881–1.000, P \ 0.01). Conclusion The RTS may be a potential predictor of acute mortality in open pelvic fracture patients. Further work would be required to validate the clinical efficacy of the generated scoring formula.
Introduction Management of pelvic fractures remains challenging for orthopedic surgeons. Difficulties include not only the complexity of the fracture pattern, but also injuries in associated major organs. A pelvic fracture followed by
& Yi-Hsun Yu [email protected] 1
Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin St. Kweish, 33302 Tao-Yuan, Taiwan
vital organ injuries, such as blunt chest and abdominal trauma and great vessel damages, could lead to a patient’s death [1, 2]. Previous studies have demonstrated that primary causes of death in patients with pelvic fractures are often injuries, and not fractures themselves [3, 4]. However, it is important to note that such studies have largely focused on injuries in closed pelvic fractures. Indeed, compared to closed ones, open pelvic fractures are less common [5] but can have much higher mortality rate of almost 50% [6]. While this number has significantly decreased thanks to improvements in pre-hospital care, r
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