INNOMINOSACRAL DISSOCIATION - MECHANISM OF INJURY AS A PREDICTOR OF RESUSCITATION REQUIREMENTS, MORBIDITY, AND MORTALITY

Objectives: To assess mechanism of injury as a clinical course predict or in patients with complete anterior and posterior pelvic ring disrup tions [innominosacral dissociation (ISD)]. Design: Retrospective revie w of radiographs and medical data. Setting: R Adams Cowley Shock Traum a Center, Baltimore, Maryland, statewide trauma center. Patients: Fort y-three patients with ISD were admitted to our institution between Aug ust 1986 and October 1991. Five patients were excluded because of inco mplete medical records (4) or refusal of blood transfusion (1). Interv ention: Injuries were grouped according to the Young classification: 1 8 anteroposterior compression (APC), 14 vertical shear (VS), and 6 oth er injuries. Main Outcome Measurements: The mean blood re placement re quirements, incidence of multiple organ system failure, mortality rate , and length of hospital stay for each injury classification were coma pared. Results: The mean ISS was 34, and the mean 24-hour packed red b lood cell transfusion requirement was 12.6 units. Thirteen patients (3 4.4%) developed multisystem organ failure. Eight patients (21%) died. Patients in the APC group were more likely to require greater than or equal to 10 units of blood (15/18, p = 0.001, and those in the VS grou p were more likely to receive <10 units (11/14, p = 0.0014). Multisyst em organ failure occurred more frequently (11/18 versus 2/14; p < 0.00 5), mortality was significantly higher (39 versus 0%, respectively; p = 0.01), and mean hospital stay for survivors was longer (48 versus 27 days; p < 0.025) in the APC than in the VS group, respectively. Concl usions: These findings suggest that mechanism of injury is an importan t determinant of clinical behavior in patients with IDS, and that ISD secondary to the APC mechanism is associated with substantially greate r resuscitation requirements, morbidity, and mortality than ISD second ary to the VS mechanism.