Portal de Periódicos da CAPES

Auditing 655 Fatalities with Pelvic Fractures by Autopsy as a Basis to Evaluate Trauma Care

2006; Lippincott Williams & Wilkins; Volume: 203; Issue: 1 Linguagem: Inglês

10.1016/j.jamcollsurg.2006.03.017

1879-1190

Iordanis N. Papadopoulos, Nikolaos K. Kanakaris, Stefanos Bonovas, Aristidis Triantafillidis, Christos Garnavos, Dionisios Voros, Christos Leukidis,

Abdominal Trauma and Injuries

To determine the role of pelvic fractures in auditing mortality resulting from trauma.This retrospective case-control study based on autopsy-evaluated circumstances of the deaths of patients with pelvic fractures.Of 2,583 patients injured in motor-vehicle collisions, 655 (25.4%) constituted the pelvic fracture (PFx) group, and 1,928 (74.6%) constituted the control group. One-third of the PFx group's fatalities had an Injury Severity Score (ISS) of 75 and were not preventable. The PFx group had a substantially higher median ISS than the control group (50 versus 34; p < 0.0001). Four hundred fifty-four patients (69.3%) in the PFx group with ISS 16 to 74 had substantially higher rates of associated injuries. Nearly half of the PFx group patients with ISS <or= 74 had a potential cause of major hemorrhage other than pelvic fracture. Twenty-three (3.5%) deaths were directly attributable to pelvic fractures. Postinjury median survival time was 55 minutes for the PFx group and 100 minutes for the control group (p < 0.0001). The time limit for management of the patients with pelvic fractures was short, as 527 (81.5%) died in the first 6 hours. It was evident that the more severe the injuries were, the sooner the deaths occurred. Of 151 subjects who left the emergency department alive, 61.6% were subjected to operation and 48.3% to abdominal operation.Pelvic fracture is an indicator of severe multiple trauma, but a small proportion of deaths are directly attributable to pelvic fracture. A method based on autopsy audited patients with pelvic fractures as a paradigm of injury revealed that pelvic fracture is an important injury to consider in auditing trauma care and indicated several issues that should be considered to reduce mortality.