title: The epidemiology of pelvic ring fractures: a population-based study.
abstract: BACKGROUND
  The severity of pelvic ring fractures (PRFs) can range from minor injury with low-energy mechanism to high-energy injury causing prehospital death. The purpose of this study was to prospectively describe the comprehensive pelvic fracture occurrence in an inclusive trauma system.
  
  
  METHODS
  A 12-month prospective, population-based epidemiologic study was performed in the Hunter Region, New South Wales, Australia (population of 600,000, served by one Level I trauma center and 7 referring hospitals). Patient demographics, mechanism, injury severity, shock parameters, and outcomes were recorded prospectively. The database included all pelvic fractures from the region: high-energy pelvic fractures (HE-PRFs), low-energy pelvic fractures (LE-PRFs), and prehospital deaths (PD-PRFs).
  
  
  RESULTS
  The incidence of PRF in the trauma system was 23 per 100,000 persons (138 fractures). The incidences of HE-PRF and LE-PRF were each 10 per 100,000 persons, whereas there were 3 PD-PRFs per 100,000. HE-PRF compared with LE-PRF occurred predominantly in men (64% vs. 20%, p < 0.05), younger persons (41 +/- 3 vs. 83 +/- 1 years, p < 0.05), those who had a higher Injury Severity Score (23 +/- 3 vs. 6 +/- 1, p < 0.05), and those with lower blood pressure (111 +/- 1 mm Hg vs. 153 +/- 1 mm Hg, p < 0.05), but the inhospital mortality rate was not statistically different (15% vs. 8%, p = NS). The overall mortality of the cohort was 23% (60% of those were from the PD-PRF group). The PRF-related mortality was 7% (HE-PRF: 7%; LE-PRF: 2%; PD-PRF: 33%), which was always attributable to bleeding. The incidence of demonstrated pelvic fracture-related arterial bleeding was 1.3 per 100,000 persons per year.
  
  
  CONCLUSIONS
  LE-PRF and HE-PRF are equally frequent among hospital admissions. They represent two distinct demographic groups with similar mortality rate. Most PRF-related deaths occur prehospitally. Bleeding remains the primary cause of PRF-related mortality in all groups.
authors.affiliation: Department of Trauma, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales, Australia. zsolt.balogh@hnehealth.nsw.gov.au
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Balogh
authors.forename: Kate L
authors.initials: KL
authors.lastname: King
authors.forename: Peter
authors.initials: P
authors.lastname: Mackay
authors.forename: Debra
authors.initials: D
authors.lastname: McDougall
authors.forename: Stuart
authors.initials: S
authors.lastname: Mackenzie
authors.forename: Julie A
authors.initials: JA
authors.lastname: Evans
authors.forename: Timothy
authors.initials: T
authors.lastname: Lyons
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Deane
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D010384:Pelvic Bones / Q000293:injuries*; D011446:Prospective Studies; D016019:Survival Analysis; D014947:Wounds and Injuries / Q000453:epidemiology