MORTALITY IN MULTIPLE TRAUMA PATIENTS WITH FRACTURES

A multicentered study was performed to determine the mortality rate of patients with multiple injuries with major pelvic and long bone fract ures who have early total care of their injuries. A 2-year review of p atients with ISSs greater-than-or-equal-to 18 with major fractures tre ated at the trauma centers in Buffalo, New York, Camden, New Jersey, N ashville, Tennessee, Baltimore, Maryland, Tampa, Florida, and Seattle, Washington was performed. This group of 676 patients was compared wit h a similar group of 906 patients from the American College of Surgeon s' Multiple Trauma Outcome Study. Mortality was significantly reduced in the patients who had early total care of all their injuries includi ng fracture stabilization for patients less than 50 years of age and t hose 50 years and older. In a subgroup of patients less than 50 years of age and an ISS of 18-34 and 35-45 there was a mortality reduction f rom 11.8% to 5.1% and from 25.8% to 11.5%, respectively, when the frac tures were managed acutely. Similar reductions in mortality were found in the patients 50 years of age and older with early fracture stabili zation with a reduction from 26.4% to 8% in patients with ISSs of 18-2 4 and a reduction from 42.3% to 18.4% in the patients with ISSs of 35- 45. This study clearly shows the additional benefit of early fracture stabilization in reducing mortality rates in the patient with multiple injuries.