What are Predictors of Mortality in Patients with Pelvic Fractures?

Our knowledge of factors influencing mortality of patients with pelvic ring injuries and the impact of associated injuries is currently based on limited information. We identified the (1) causes and time of death, (2) demography, and (3) pattern and severity of injuries in patients with pelvic ring fractures who did not survive. We prospectively collected data on 5340 patients listed in the German Pelvic Trauma Registry between April 30, 2004 and July 29, 2011; 3034 of 5340 (57%) patients were female. Demographic data and parameters indicating the type and severity of injury were recorded for patients who died in hospital (nonsurvivors) and compared with data of patients who survived (survivors). The median followup was 13 days (range, 0-1117 days). A total of 238 (4%) patients died a median of 2 days after trauma. The main cause of death was massive bleeding (34%), predominantly from the pelvic region (62% of all patients who died because of massive bleeding). Fifty-six percent of nonsurvivors and 43% of survivors were male. Nonsurvivors were characterized by a higher incidence of complex pelvic injuries (32% versus 8%), less isolated pelvic ring fractures (13% versus 49%), lower initial blood hemoglobin concentration (6.7 +/- A 2.9 versus 9.8 +/- A 3.0 g/dL) and systolic arterial blood pressure (77 +/- A 27 versus 106 +/- A 24 mmHg), and higher injury severity score (ISS) (35 +/- A 16 versus 15 +/- A 12). Patients with pelvic fractures who did not survive were characterized by male gender, severe multiple trauma, and major hemorrhage. Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.