Survival trends and predictors of mortality in severe pelvic trauma: estimates from the German Pelvic Trauma Registry Initiative |
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| Authors: | Pohlemann Tim Stengel Dirk Tosounidis Georgios Reilmann Heinrich Stuby Fabian Stöckle Uli Seekamp Andreas Schmal Hagen Thannheimer Andreas Holmenschlager Francis Gänsslen Axel Rommens Pol Maria Fuchs Thomas Baumgärtel Friedel Marintschev Ivan Krischak Gert Wunder Stephan Tscherne Harald Culemann Ulf |
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| Affiliation: | aDepartment of Trauma, Hand, and Reconstructive Surgery, Faculty of Medicine, Saarland University, Homburg, Saar, Germany;bCenter for Clinical Studies, German Trauma Society (DGU) and Department of Trauma and Orthopedic Surgery, University of Greifswald, 12683 Berlin, Germany;cDepartment of Trauma and Orthopaedic Surgery, Municipal Hospital Holwedestrasse, Braunschweig, Germany;dDepartment of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Germany;eDepartment of Trauma and Orthopaedic Surgery, Technical University of Munich, Germany;fDepartment of Traumatology, University of Schleswig-Holstein, Kiel Campusm, Germany;gDepartment of Trauma and Orthopaedic Surgery, University of Freiburg, Germany;hDepartment of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Germany;iTrauma Department, University of Magdeburg, Germany;jDepartment of Traumatology, General Hospital of Celle, Germany;kTrauma Department, Mainz University Hospital, Germany;lDepartment of Trauma, Hand and Reconstructive Surgery, University of Münster, Germany;mTrauma Department, Evangelisches Stift St. Martin, Koblenz, Germany;nDepartment of Trauma-, Hand- and Reconstructive Surgery, University of Jena, Germany;oDepartment of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University of Ulm, Germany;pTrauma Department, Friederikenstift Hannover, Germany |
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| Abstract: | Study objectiveTo determine longitudinal trends in mortality, and the contribution of specific injury characteristics and treatment modalities to the risk of a fatal outcome after severe and complex pelvic trauma.MethodsWe studied 5048 patients with pelvic ring fractures enrolled in the German Pelvic Trauma Registry Initiative between 1991 and 1993, 1998 and 2000, and 2004 and 2006. Complete datasets were available for 5014 cases, including 508 complex injuries, defined as unstable fractures with severe peri-pelvic soft tissue and organ laceration. Multivariable mixed-effects logistic regression analysis was employed to evaluate the impact of demographic, injury- and treatment-associated variables on all-cause in-hospital mortality.ResultsAll-cause in-hospital mortality declined from 8% (39/466) in 1991 to 5% (33/638) in 2006. Controlling for age, Injury Severity Score, pelvic vessel injury, the need for emergency laparotomy, and application of a pelvic clamp, the odds ratio (OR) per annum was 0.94 (95% confidence interval [CI] 0.91–0.96). However, the risk of death did not decrease significantly in patients with complex injuries (OR 0.98, 95% CI 0.93–1.03). Raw mortality associated with this type of injury was 18% (95% CI 9–32%) in 2006.ConclusionIn contrast to an overall decline in trauma mortality, complex pelvic ring injuries remain associated with a significant risk of death. Awareness of this potentially life-threatening condition should be increased amongst trauma care professionals, and early management protocols need to be implemented to improve the survival prognosis. |
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| Keywords: | Pelvic trauma Survival Epidemiology Registry Complex injuries |
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