The Effect of Delayed Presentation and Surgery in Pelvic Trauma on Morbidity and Mortality

Abstract

Introduction:The presentation of pelvic trauma patients can be time critical. This study will aim to identify the impact of delayed presentation in pelvic trauma patients on morbidity and mortality and identify the effect of time to pelvic surgery on patient outcomes. Methods:Patients presenting to a Level 1 Trauma Centre between July 2001 and June 2014 with major pelvic trauma were retrospectively identified using two prospective databases. Time from injury to arrival and surgery and referral from another hospital were identified. Outcomes included intensive care (ICU) admission, length of stay and mortality.Results: 1300 patients were identified. 133 (10.2%) patients were transferred from a rural hospital. The risk of death was higher in patients presenting directly (11.6% vs. 6.1%, p=0.028), although their Injury Severity Score was higher (28.1 vs. 24.0, p<0.001). There was no difference in ICU days (3.95 vs. 3.58, p=0.50) or length of stay (14.97 vs. 15.81, p=0.50). Transfer was more timely if ICU was required (17.9 vs. 46.8 hours, p=0.028). Pelvic surgery occurred in 79 (43.9%) in the transferred group and 370 (33.0%) patients presenting directly. Conclusions:Mortality is not increased with initial presentation at rural hospitals, although these patients had less severe injury. There is a higher mortality with earlier surgery, although this likely reflects the seriousness of the patient's condition rather than the surgery itself.This study aims to identify the impact delayed presentation has on morbidity and mortality in pelvic trauma patients. It will examine the effect of initial presentation at a rural or other metropolitan non-Level 1 Trauma Centre prior to definitive management at a Level 1 Trauma Centre. Finally this study will identify the effect of time to pelvic surgery on patient outcomes. MethodsA retrospective review of patients with major pelvic trauma