Pelvic fracture among polytrauma decedents - Trauma-based mortality with pelvic fracture - a case series of 74 patients

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.