Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study

Abstract

BackgroundPelvic fractures are severe injuries with frequently associated multi-system trauma and a high mortality rate. The value of the pelvic fracture pattern for predicting transfusion requirements and mortality is not entirely clear. To address hemorrhage from pelvic injuries, the early application of pelvic binders is now recommended and arterial angio-embolization is widely used for controlling arterial bleeding. Our aim was to assess the association of the pelvic fracture pattern according to the Tile classification system with transfusion requirements and mortality rates, and to evaluate the correlation between the use of pelvic binders and arterial angio-embolization and the mortality of patients with pelvic fractures.MethodsSingle-center retrospective cohort study including all consecutive patients with a pelvic fracture from January 2008 to June 2015. All radiological fracture patterns were independently reviewed and grouped according to the Tile classification system. Data on patient demographics, use of pelvic binders and arterial angio-embolization, transfusion requirements and mortality were extracted from the institutional trauma registry and analyzed.ResultsThe present study included 228 patients. Median patient age was 43.5 years and 68.9% were male. The two independent observers identified 105 Tile C (46.1%), 71 Tile B (31.1%) and 52 Tile A (22.8%) fractures, with substantial to almost perfect interobserver agreement (Kappa 0.70-0.83). Tile C fractures were associated with a higher mortality rate (p = 0.001) and higher transfusion requirements (p < 0.0001) than Tile A or B fractures. Arterial angio-embolization for pelvic bleeding (p = 0.05) and prehospital pelvic binder placement (p = 0.5) were not associated with differences in mortality rates.ConclusionsTile C pelvic fractures are associated with higher transfusion requirements and a higher mortality rate than Tile A or B fractures. No association between the use of pelvic binders or arterial angio-embolization and survival was observed in this cohort of patients with pelvic fractures.

Pelvic injury prognosis is more closely related to vascular injury severity than anatomical fracture complexity: The WSES classification for pelvic trauma makes sense

“…As reported by Lunsjo et al [17] and Agri et al [21], most deaths related to pelvic fracture were caused by associated injuries, not the pelvic fracture itself. In these patients, the most common cause of death was severe traumatic brain injury [17,21,22]. Therefore, to speci cally investigate the correlation of the fracture pattern and pelvic vascular injury severity with the outcome, patients with an AIS score higher than 2 for body regions other than the pelvis were excluded from the current study.…”

“…Most exsanguinating patients could be stabilized by transarterial embolization shortly after initial resuscitation whenever indicated [20,25,27,28]. Another reason for the lack of mortality was that pelvic trauma patients with associated injuries that were con rmed to be the principal cause of death, such as severe brain injury, were not included in the current study [17,[21][22][23].…”

Prehospital use of pelvic circumferential compression devices in a physician-based emergency medical service: A 6-year retrospective cohort study

“…The interobserver reliability of the Tile classification system has been previously described as low and insufficient for research purposes 48 . In a previous paper -using a different set of observers -on a cohort with all pelvic ring injuries admitted to our hospital, we obtained a different distribution of fracture types 49 . Although the present study included only patients treated in a physician-staffed prehospital setting, the interobserver variability may influence our results and limit their value.…”

Patterns, Management and Outcomes of Traumatic Pelvic Fracture: Insights from A Multicenter Study

“…Agri et al [32] reported that Tile C fractures are significantly associated with more blood transfusion and a higher rate of mortality as compared to Tile A or B fractures. Unstable fracture is really the most serious skeletal injury due to complexity and high-energy related to other anatomical injuries [33].…”