Auditing 655 fatalities with pelvic fractures by autopsy as a basis to evaluate trauma care.
BACKGROUND
To determine the role of pelvic fractures in auditing mortality resulting from trauma.


METHODS
This retrospective case-control study based on autopsy-evaluated circumstances of the deaths of patients with pelvic fractures.


RESULTS
Of 2,583 patients injured in motor-vehicle collisions, 655 (25.4%) constituted the pelvic fracture (PFx) group, and 1,928 (74.6%) constituted the control group. One-third of the PFx group's fatalities had an Injury Severity Score (ISS) of 75 and were not preventable. The PFx group had a substantially higher median ISS than the control group (50 versus 34; p < 0.0001). Four hundred fifty-four patients (69.3%) in the PFx group with ISS 16 to 74 had substantially higher rates of associated injuries. Nearly half of the PFx group patients with ISS <or= 74 had a potential cause of major hemorrhage other than pelvic fracture. Twenty-three (3.5%) deaths were directly attributable to pelvic fractures. Postinjury median survival time was 55 minutes for the PFx group and 100 minutes for the control group (p < 0.0001). The time limit for management of the patients with pelvic fractures was short, as 527 (81.5%) died in the first 6 hours. It was evident that the more severe the injuries were, the sooner the deaths occurred. Of 151 subjects who left the emergency department alive, 61.6% were subjected to operation and 48.3% to abdominal operation.


CONCLUSIONS
Pelvic fracture is an indicator of severe multiple trauma, but a small proportion of deaths are directly attributable to pelvic fracture. A method based on autopsy audited patients with pelvic fractures as a paradigm of injury revealed that pelvic fracture is an important injury to consider in auditing trauma care and indicated several issues that should be considered to reduce mortality.
Papadopoulos
Iordanis N
IN
National University of Athens, Attikon University General Hospital, Athens, Greece. ipapado@med.uoa.gr
Kanakaris
Nikolaos
N
Bonovas
Stefanos
S
Triantafillidis
Aristidis
A
Garnavos
Christos
C
Voros
Dionisios
D
Leukidis
Christos
C
D000063:Accidents, Traffic / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D006115:Greece; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit / Q000379:methods*; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D012189:Retrospective Studies; D014194:Traumatology