title: Improved Survival After Pelvic Fracture: 13-Year Experience at a Single Trauma Center Using a Multidisciplinary Institutional Protocol.
abstract: OBJECTIVE
  To analyze pelvic fracture mortality rates before and after initiation of a multidisciplinary pelvic fracture protocol.
  
  
  METHODS
  Retrospective database analysis.
  
  
  METHODS
  Prospective data from our Level-I National Trauma Registry of The American College of Surgeons (NTRACS) database.
  
  
  METHODS
  A total of 1682 trauma patients with pelvic fractures from 2000 to 2013 were compared with a control group of 42,629 without pelvic fractures.
  
  
  METHODS
  Initiation of a multidisciplinary institutional protocol to guide the initial management of trauma patients with pelvic fractures.
  
  
  METHODS
  Patients were grouped into 3 periods (group 1: 2000-2003, group 2: 2004-2007, group 3: 2008-2013). Multivariate logistic regression analysis was conducted to assess associations between mortality and age, shock (systolic blood pressure less than or equal to 90 mm Hg), head injury (Glasgow Coma Scale less than or equal to 8), Injury Severity Score (ISS), and time period.
  
  
  RESULTS
  Unadjusted mortality rates decreased [12.5%-11.0% (P = 0.72)]; however, ISS increased [19.1-22.7 (P < 0.01)]. Age, shock, head injury, increasing ISS, and earlier period were significantly associated with mortality. Adjusted mortality decreased over time [odds ratio for 2000-2003 vs. 2008-2013: 2.05, 95% confidence interval = (1.26, 3.33) and odds ratio for 2004-2007 vs. 2008-2013: 1.71, 95% confidence interval = (1.09, 2.67)]. From 2000 to 2003, an unstable fracture pattern in the healthiest cohort significantly increased mortality compared with the stable fracture pattern cohort (8.6% and 0.0%, P < 0.01). In subsequent intervals, there was no statistically significant association between stable versus unstable fracture patterns and mortality.
  
  
  CONCLUSIONS
  Adjusted pelvic fracture mortality rates have significantly decreased over time. In the healthiest patients with unstable pelvic fractures, the mortality rate is now similar to that of patients with stable fracture patterns. With sustained institutional effort to address pelvic fractures, mortality rates can be diminished.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Departments of Orthopaedic Surgery and General Surgery, University of Texas Southwestern Medical Center, Dallas, TX; and†Texas Scottish Rite Hospital for Children, Dallas, TX.
authors.forename: Sheena R
authors.initials: SR
authors.lastname: Black
authors.forename: Ashoke K
authors.initials: AK
authors.lastname: Sathy
authors.forename: ChanHee
authors.initials: C
authors.lastname: Jo
authors.forename: Marcel R
authors.initials: MR
authors.lastname: Wiley
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Minei
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Starr
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D006259:Craniocerebral Trauma / Q000401:mortality; D019091:Critical Pathways; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods / Q000401:mortality; D050723:Fractures, Bone / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000706:statistics & numerical data*; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery*; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D012769:Shock / Q000401:mortality*; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult