M. Rittmeister et al., Pelvic fracture among polytrauma decedents - Trauma-based mortality with pelvic fracture - a case series of 74 patients, ARCH ORTHOP, 121(1-2), 2001, pp. 43-49
Pelvic fractures (PF) sustained from accidents are commonly believed to be
a major cause of mortality in polytraumatized patients. The purpose of this
paper is to determine whether PF are usually the primary cause or a contri
buting cause of mortality in these patients. A 10-year retrospective review
was performed of all polytrauma patients with PF who were admitted to, and
died, at a large, level-I trauma center. The pelvic injury was graded acco
rding to Schatzker and Tile into stable (type A), partially stable (type B)
, and unstable (type C). The injury severity score (ISS), which incorporate
s associated injuries and their potential impact on mortality, was calculat
ed for all patients. For each patient, a separate subjective designation of
the probable cause of death was determined. We identified 74 decedents wit
h PF following deceleration trauma. The pelvic fractures were classified as
12 type A (16%), 36 type B (49%), and 26 type C (35%). The mean ISS was ex
tremely high, 40.6 +/- 1.4 (range 18-75), more than four times the score fo
r simply a severe PE The ISS was also not significantly different among the
three pelvic fracture groups (P = 0.613). The records subjectively identif
ied PF as the precipitating cause of death in only 13% of the patients. In
this study, patients who died with PF had an ISS that implicated at least o
ne or two additional major visceral injuries. These data do not support the
hypothesis that PF, regardless of its complexity, is the usual primary cau
se or the major precipitating event of death in the polytraumatized patient
. In these patients, mortality appears to be a function of the associated i
njuries based on the ISS calculation.