title: Impact of pelvic fractures on the early clinical outcomes of severely injured trauma patients.
abstract: BACKGROUND
  Pelvic fractures contribute to morbidity and mortality following injury. We sought to study the impact of pelvic fractures on the clinical course and outcomes of trauma patients with a pelvic fracture in comparison to patients with similar injury severity without pelvic fracture to identify potential parameters to track patients' clinical course post-injury.
  
  
  METHODS
  A cohort of 206 consecutive blunt trauma survivors, studied over a 5-year period in a level I trauma center of which 75 patients (36.4%) had a pelvic fracture, was included in the study. To perform a retrospective cohort study with matched controls, 60 patients of the pelvic fracture group [(PF), 41 males and 19 females; age: 40 ± 17; injury severity score (ISS): 26.6 ± 9.3] were compared to 60 patients without pelvic fracture (non-PF) trauma as controls (41 males and 19 females; age: 40 ± 13; ISS: 26.9 ± 7.7), both with matching age (±5 years), sex, and ISS (±5 points).
  
  
  RESULTS
  Statistically significant differences were observed in Intensive Care Unit (ICU) length of stay (LOS), total LOS, and Marshall MOD score between PF and non-PF groups, respectively. Acid-base markers such as pH, lactate, LDH, and base deficit were all significantly altered in PF compared to non-PF cohort upon admission. Moreover, our analysis showed significant differences in inflammatory biomarkers (Prolactin, CRP, and IL-6), and clinical parameters (CPK, Hgb, Platelets count, and WBC) over the 7-day clinical course in patients with PF when compared to non-PF cohort.
  
  
  CONCLUSIONS
  In this matched cohort, patients with pelvic fractures exhibited biochemical and physiological alterations upon admission. Furthermore, our results suggest that pelvic fracture affects the clinical outcomes in severely injured patients, independently of injury severity, mechanism of injury, age or gender.
authors.affiliation: Department of Orthopaedic Trauma Surgery, University of Aachen Medical Centre, 52074, Aachen, Germany.|Department of Surgery, Division of Trauma and Critical Care Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA.|Department of General Surgery, Methodist Dallas Health System, Dallas, TX, 75203, USA.
authors.forename: K
authors.identifier: http://orcid.org/0000-0001-9716-3778
authors.initials: K
authors.lastname: Almahmoud
authors.affiliation: Department of Orthopaedic Trauma Surgery, University of Aachen Medical Centre, 52074, Aachen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Pfeifer
authors.affiliation: Department of Molecular Bioscience, University of Kansas, Kansas, 66045, USA.
authors.forename: K
authors.initials: K
authors.lastname: Al-Kofahi
authors.affiliation: Department of Orthopaedic Trauma Surgery, University of Aachen Medical Centre, 52074, Aachen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hmedat
authors.affiliation: Department of Orthopaedic Trauma Surgery, University of Aachen Medical Centre, 52074, Aachen, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Hyderabad
authors.affiliation: Department of Orthopaedic Trauma Surgery, University of Aachen Medical Centre, 52074, Aachen, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Hildebrand
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Peitzman
authors.affiliation: Department of Orthopaedic Trauma Surgery, University of Aachen Medical Centre, 52074, Aachen, Germany. hpape@ukaachen.de.
authors.forename: H-C
authors.initials: HC
authors.lastname: Pape
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000401:mortality*; D005858:Germany; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D009104:Multiple Trauma / Q000401:mortality*; D010384:Pelvic Bones / Q000293:injuries*; D012189:Retrospective Studies
keywords: Clinical outcomes; Clinical parameters; Damage control; Injury; Pelvic fracture; Trauma