Predictors of Acute Mortality After Open Pelvic Fracture: Experience From 37 Patients From A Level I Trauma Center

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2020 Jul 8

PMID 32632642

Citations 6

Authors

I-Chuan Tseng

I-Jung Chen

Ying-Chao Chou

Yung-Heng Hsu

Yi-Hsun Yu

Affiliations

Soon will be listed here.

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.

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References

Rothenberger D, Velasco R, Strate R, Fischer R, PERRY Jr J . Open pelvic fracture: a lethal injury. J Trauma. 1978; 18(3):184-7. View

Kunitake R, Kornblith L, Cohen M, Callcut R . Trauma Early Mortality Prediction Tool (TEMPT) for assessing 28-day mortality. Trauma Surg Acute Care Open. 2018; 3(1):e000131. PMC: 5887834. DOI: 10.1136/tsaco-2017-000131. View

Cannada L, Taylor R, Reddix R, Mullis B, Moghadamian E, Erickson M . The Jones-Powell Classification of open pelvic fractures: a multicenter study evaluating mortality rates. J Trauma Acute Care Surg. 2013; 74(3):901-6. DOI: 10.1097/TA.0b013e3182827496. View

Rogers F, Osler T, Krasne M, Rogers A, Bradburn E, Lee J . Has TRISS become an anachronism? A comparison of mortality between the National Trauma Data Bank and Major Trauma Outcome Study databases. J Trauma Acute Care Surg. 2012; 73(2):326-31. DOI: 10.1097/TA.0b013e31825a7758. View

Staff T, Eken T, Wik L, Roislien J, Sovik S . Physiologic, demographic and mechanistic factors predicting New Injury Severity Score (NISS) in motor vehicle accident victims. Injury. 2012; 45(1):9-15. DOI: 10.1016/j.injury.2012.11.010. View

Jones A, Powell J, Kellam J, McCormack R, Dust W, Wimmer P . Open pelvic fractures. A multicenter retrospective analysis. Orthop Clin North Am. 1997; 28(3):345-50. DOI: 10.1016/s0030-5898(05)70293-5. View

Alvarez B, Razente D, Lacerda D, Lother N, VON-Bahten L, Stahlschmidt C . Analysis of the Revised Trauma Score (RTS) in 200 victims of different trauma mechanisms. Rev Col Bras Cir. 2016; 43(5):334-340. DOI: 10.1590/0100-69912016005010. View

El Mestoui Z, Jalalzadeh H, Giannakopoulos G, Zuidema W . Incidence and etiology of mortality in polytrauma patients in a Dutch level I trauma center. Eur J Emerg Med. 2015; 24(1):49-54. DOI: 10.1097/MEJ.0000000000000293. View

Fitzgerald C, Moore Jr T, Morse B, Subramanian A, Dente C, Patel D . The Role of Diverting Colostomy in Traumatic Blunt Open Pelvic Fractures. Am Surg. 2017; 83(8):e280-282. View

10.

Gustilo R, Mendoza R, Williams D . Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984; 24(8):742-6. DOI: 10.1097/00005373-198408000-00009. View

11.

Pandit V, Rhee P, Hashmi A, Kulvatunyou N, Tang A, Khalil M . Shock index predicts mortality in geriatric trauma patients: an analysis of the National Trauma Data Bank. J Trauma Acute Care Surg. 2014; 76(4):1111-5. DOI: 10.1097/TA.0000000000000160. View

12.

Holstein J, Culemann U, Pohlemann T . What are predictors of mortality in patients with pelvic fractures?. Clin Orthop Relat Res. 2012; 470(8):2090-7. PMC: 3392378. DOI: 10.1007/s11999-012-2276-9. View

13.

Keil D, Gross S, Seymour R, Sims S, Karunakar M . Mortality After High-Energy Pelvic Fractures in Patients of Age 65 Years or Older. J Orthop Trauma. 2017; 32(3):124-128. DOI: 10.1097/BOT.0000000000001041. View

14.

Jeong J, Park Y, Kim D, Kim T, Kang C, Lee S . The new trauma score (NTS): a modification of the revised trauma score for better trauma mortality prediction. BMC Surg. 2017; 17(1):77. PMC: 5496419. DOI: 10.1186/s12893-017-0272-4. View

15.

Hou Z, Smith W, Strohecker K, Bowen T, Irgit K, Baro S . Hemodynamically unstable pelvic fracture management by advanced trauma life support guidelines results in high mortality. Orthopedics. 2012; 35(3):e319-24. DOI: 10.3928/01477447-20120222-29. View

16.

Black E, Lawson C, Smith S, Daley B . Open pelvic fractures: the University of Tennessee Medical Center at Knoxville experience over ten years. Iowa Orthop J. 2011; 31:193-8. PMC: 3215135. View

17.

Coccolini F, Stahel P, Montori G, Biffl W, Horer T, Catena F . Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 2017; 12:5. PMC: 5241998. DOI: 10.1186/s13017-017-0117-6. View

18.

Kondo Y, Abe T, Kohshi K, Tokuda Y, Cook E, Kukita I . Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score. Crit Care. 2011; 15(4):R191. PMC: 3387633. DOI: 10.1186/cc10348. View

19.

Gustilo R, Anderson J . Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976; 58(4):453-8. View

20.

Giordano V, Koch H, Gasparini S, Souza F, Labronici P, do Amaral N . Open Pelvic Fractures: Review of 30 Cases. Open Orthop J. 2017; 10:772-778. PMC: 5301299. DOI: 10.2174/1874325001610010772. View