Early predictors of mortality in hemodynamically unstable pelvis fractures.
OBJECTIVE
To determine reliable, early indicators of mortality and causes of death in hemodynamically unstable patients with pelvic ring injuries.


METHODS
This was a retrospective review of a prospective pelvic database.


METHODS
In all, 187 hemodynamically unstable patients with pelvic fractures (persistent systolic blood pressure <90 mm Hg after receiving 2 L of intravenous crystalloid) admitted from April 1998 to November 2004 were included. Intervention was Level 1 Trauma Center-Pelvis Fracture standardized protocol. Main outcome measurements were: Injury Severity Score (ISS), Revised Trauma Score (RTS), age, blood transfusion, mortality, and multisystem organ failure (MOF).


RESULTS
Group 1 (39 patients) did not survive their injury. Group 2 (148 patients) survived their injury. Fracture pattern (chi(2) = 9.1, P = 0.33), and treatment with angiography/embolization (chi(2) = 0.054, P = 0.84) were not predictive of death. Patients requiring more blood had a statistically significant higher mortality rate. The ISS (t = -5.62, P < 0.001), RTS (t = 6.10, P < 0.001), age >60 years old (chi(2) = 5.4, P = 0.03), and transfusion (t = -2.70, P = 0.010) were statistically significant independent predictors of mortality. A logistic regression analysis and receiver operating characteristic curves indicated that of these variables, RTS was the most predictive independent variable. However, a model including all four variables was superior at predicting mortality. Most deaths were attributed to exsanguination (74.4%) or MOF (17.9%).


CONCLUSIONS
Predictors of mortality in pelvis fracture patients should be available early in the course of treatment in order to be useful. Death within 24 hours was most often a result of acute blood loss while death after 24 hours was most often caused by MOF. Improved survival will depend upon the evolution of early hemorrhage control and resuscitative strategies in patients at high mortality risk.
Smith
Wade
W
Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA. wsmith@dhha.org
Williams
Allison
A
Agudelo
Juan
J
Shannon
Michael
M
Morgan
Steven
S
Stahel
Phillip
P
Moore
Ernest
E
D000368:Aged; D015331:Cohort Studies; D003120:Colorado / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000401:mortality* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010384:Pelvic Bones / Q000293:injuries*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome