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Pelvic fracture in the patient with multiple injuries: factors and lesions associated with mortality




Martínez F, Alegret N, Carol F, Laso MJ, Zancajo J, García E, Ros V



Servicio de Anestesiología y Reanimación, Corporación Sanitaria Parc Taulí, Sabadell, Spain. Servicio de Cirugía Ortopédica y Traumatología, Corporación Sanitaria Parc Taulí, Sabadell, Spain.



Background and objective. The main objective of this study was to identify demographic, clinical, analytical factors or injuries associated with 30-day mortality in patients with pelvic fractures.
Methods. Prospective observational study of patients with multiple injuries including pelvic fractures between January 2009 and January 2017. We recorded demographic, clinical, and laboratory data on arrival at the emergency department; type of pelvic fracture; treatments; associated lesions; and 30-day mortality. Univariable and multivariable models
were used to analyze the data.
Results. A total of 2061 multiple-injury patients were attended; 118 had pelvic fractures. Fifteen of the patients with pelvic fractures (12.7%) died within 30 days. Arterial blood pressure on admission was less than 90 mm Hg in 23.7%, heart rate was over 100 beats per minute in 41.52%, lactic acid level was 20 mg/dL or higher in 67.6%, and base excess
of ‚Äď6 or less was recorded for 26.3%. The mean Injury Severity Score was 20 points. Angiographic embolization was required in 80.6% and preperitoneal packing in 3.4%. The main associated lesions were rib fractures (35.6%), hemo-pneumothorax (31.3%), spinal injuries (35.6%), and head injuries (30%).
Conclusions. The 6 independent variables associated with risk of death in multiple-injury patients with pelvic fractures are age, female sex, complex fractures (Tile type C), lactic acid level of 20 mg/dL or more, base excess of ‚Äď6 or less, and bowel perforation.


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