Factors affecting the prognosis of patients with traumatic pelvic bone fractures with hemodynamic instability : multi-center study

Abstract

INTRODUCTION We analyzed the effect of hemorrhage control methods on the mortality of patients with hemodynamic instability due to pelvic fracture. We also investigated independent risk factors of mortality of these patients MATERIALS AND METHODS From January 2013 to October 2017, 97 pelvic bone fracture patients with hemodynamic instability were enrolled among the patient pelvic bone fracture patients who visited the emergency departments of two university hospitals. These patients were classified into survival and non-survival groups based on '28 day mortality' and 'Acute hemorrhagic mortality', and their clinical data including laboratory finding, trauma severity score, and hemorrhage control modalities were collected. Through statistical analysis of the collected clinical information, the effect of each hemorrhagic control modality on mortality was analyzed. Multivariate logistic regression was performed to determine the independent risk factors for the mortality of pelvic fracture patients with hemodynamic instability. RESULTS Among 97 patients who were enrolled, overall mortality was 40 (41.24%), 28 day mortality was 37 (38.14%), and acute hemorrhage mortality was 28 (28.86%). Among the hemorrhage control modality, 47 patients (48.5%) underwent pelvic angiography, 45 patients (46.4%) underwent pre-peritoneal pelvic packing(PPP), and 19 patients (19.6%) underwent external fixation(EF). The difference in hemorrhage control method had no significant effect on the mortality of these patient. However, there was a significant difference in mortality between the groups with and without any of the hemorrhage control methods. A multivariate logistic regression analysis revealed that age of patient (odds ratio [OR] = 1.056, 95% confidence interval [CI] = 1.020 – 1.093, p = 0.002), TRISS (probability of survival) (OR = 0.976, 95% CI = 0.956 – 0.997, p = 0.022), transfusion amount within 24hours (OR = 1.084, 95% CI = 1.015 – 1.156, p = 0.016) were independent factors for mortality within 28 day. With the same statistical analysis, age of patient (OR = 1.050, 95% CI = 1.014 – 1.087, p = 0.006), transfusion amount within 24hours (OR = 1.094, 95% CI = 1.025 – 1.169, p = 0.007), glasgow coma scale(GCS) (OR = 0.852, 95% CI = 0.740 – 0.981, p = 0.026) and systolic blood pressure(SBP) (OR = 0.978, 95% CI = 0.960 – 0.997, p = 0.025) were revealed as independent factors for mortality of acute hemorrhage. CONCLUSION Hemorrhage control methods such as angiography, PPP, EF can help to reduce acute hemorrhage mortality in hemodynamically unstable patients by pelvic fracture, however, there was no significant difference in mortality according to the difference in hemorrhage control methods. Old age, high transfusion requirements, low TRISS score, low GCS, and low SBP are independent risk factors for mortality of pelvic fracture patients with hemodynamic instability.