title: Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality.
abstract: BACKGROUND
  Unstable pelvic fracture is predominantly caused by high-energy blunt trauma and is associated with a high risk of mortality. The epidemiology in the United States is largely unknown. The purpose of this study was to examine the epidemiology of unstable pelvic fracture based on patient and hospital demographics in the United States during the last decade.
  
  
  METHODS
  The Nationwide Inpatient Sample was used to identify patients who were hospitalized with unstable pelvic fracture from 2000 to 2009, using the International Classification of Diseases--9th Rev.--Clinical Modification (ICD-9-CM) codes. The primary outcome parameter consisted of analyzing the temporal trends of in-hospital admissions for unstable pelvic fracture and the associated in-hospital mortality. The data were stratified by demographic variables, including age, sex, race, and hospital region in the United States.
  
  
  RESULTS
  From 2000 to 2009, there were 24,059 patients in total; among these, 1,823 (7.6%) had open fractures, and 22,236 (92.4%) had closed fractures. The population growth-adjusted incidence was stable over time (p = 0.431). The incidence was the lowest in the northeastern region. The in-hospital mortality rate in patients with unstable pelvic fracture was 8.3% (21.3% for open fracture, 7.2% for closed fracture) and remained stable over time (p = 0.089). The in-hospital mortality rate was higher in several subgroups of patients, such as older patients, male patients, African-American patients, and patients in the northeastern region.
  
  
  CONCLUSIONS
  During the last decade, the incidence of unstable pelvic fracture has remained stable over time in the United States. The in-hospital mortality rate in patients with unstable pelvic fracture was 8.3% and remained stable over time. The rate in patients with an open fracture was approximately three times higher than that in patients with a closed fracture. The incidence was the lowest, but the in-hospital mortality rate was the highest in the northeastern region compared with the other three regions.
  
  
  METHODS
  Epidemiologic study, level III.
authors.affiliation: From the Department of Orthopaedic Surgery (H.Y.), NYU Hospital for Joint Diseases, New York, New York; Department of Orthopaedic Surgery (H.Y.), Nagoya City University Graduate School of Medical Sciences, Nagoya; Department of Statistical Science (D.Y.), School of Advanced Sciences, The Graduate University for Advanced Studies, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshihara
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoneoka
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D011379:Prognosis; D011859:Radiography; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult