title: Survival trends and predictors of mortality in severe pelvic trauma: estimates from the German Pelvic Trauma Registry Initiative.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  All-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.
  
  
  CONCLUSIONS
  In 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.
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, Faculty of Medicine, Saarland University, Homburg, Saar, Germany. tim.pohlemann@uks.eu
authors.forename: Tim
authors.initials: T
authors.lastname: Pohlemann
authors.forename: Dirk
authors.initials: D
authors.lastname: Stengel
authors.forename: Georgios
authors.initials: G
authors.lastname: Tosounidis
authors.forename: Heinrich
authors.initials: H
authors.lastname: Reilmann
authors.forename: Fabian
authors.initials: F
authors.lastname: Stuby
authors.forename: Uli
authors.initials: U
authors.lastname: Stöckle
authors.forename: Andreas
authors.initials: A
authors.lastname: Seekamp
authors.forename: Hagen
authors.initials: H
authors.lastname: Schmal
authors.forename: Andreas
authors.initials: A
authors.lastname: Thannheimer
authors.forename: Francis
authors.initials: F
authors.lastname: Holmenschlager
authors.forename: Axel
authors.initials: A
authors.lastname: Gänsslen
authors.forename: Pol Maria
authors.initials: PM
authors.lastname: Rommens
authors.forename: Thomas
authors.initials: T
authors.lastname: Fuchs
authors.forename: Friedel
authors.initials: F
authors.lastname: Baumgärtel
authors.forename: Ivan
authors.initials: I
authors.lastname: Marintschev
authors.forename: Gert
authors.initials: G
authors.lastname: Krischak
authors.forename: Stephan
authors.initials: S
authors.lastname: Wunder
authors.forename: Harald
authors.initials: H
authors.lastname: Tscherne
authors.forename: Ulf
authors.initials: U
authors.lastname: Culemann
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality; D000063:Accidents, Traffic; D000328:Adult; D000368:Aged; D004812:Epidemiologic Methods; D005260:Female; D005592:Fracture Fixation / Q000379:methods; D050723:Fractures, Bone / Q000401:mortality* / Q000628:therapy; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality* / Q000628:therapy; D010384:Pelvic Bones / Q000293:injuries*; D012042:Registries / Q000706:statistics & numerical data; D016019:Survival Analysis; D057772:Vascular System Injuries; D055815:Young Adult