Schulman Jeff E, O'Toole Robert V, Castillo Renan C, Manson Theodore, Sciadini Marcus F, Whitney Augusta, Pollak Andrew N, Nascone Jason W
Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
J Trauma. 2010 Apr;68(4):930-4. doi: 10.1097/TA.0b013e3181cb49d1.
It is unknown whether pelvic ring fracture is an independent predictor of death after blunt trauma. Few previous studies have attempted to analyze whether the high death rate observed in association with pelvic ring injury is secondary to the pelvic ring injury or merely related to many other injuries that typically are sustained in such cases. Our hypothesis was that pelvic ring fracture is an independent risk factor for death, even after accounting for the risk of death from other associated injuries.
We reviewed the records of 31,550 patients who presented with blunt trauma at our Level I trauma center from 1995 to 2002. We analyzed our prospectively collected database and excluded any patient who was missing more than one demographic parameter (n = 414, 1.3% of the data set). Our study group consisted of 1,017 patients with pelvic ring fractures and 30,119 patients with blunt trauma without pelvic ring fractures. Multiple logistic regression analysis was conducted to account for the relative contribution of associated clinical criteria to mortality. A mortality model was then designed by using the regression analysis, allowing us to compare a calculated chance of death for each patient in the study group. We then compared the expected number of deaths of patients with pelvic injury with the actual number of observed deaths in that data set. Additionally, we conducted a second statistical analysis with which we compared the death rate of our pelvic ring fracture population (n = 1,017) with a matched subgroup (n = 1,017) from our patient population without pelvic ring fractures (n = 30,119).
The presence of pelvic ring fracture was found to be an independent risk factor for mortality in the blunt trauma population based on both statistical methods (odds ratios, 1.9 [p < 0.001] and 2.1 [p < 0.0007]). Other significant predictors of mortality included patient age, Injury Severity Score, Glasgow Coma Scale score, systolic blood pressure and respiratory rate at admission, and several medical comorbidities.
The presence of pelvic ring fracture seems to represent a clinically significant independent risk factor for mortality, even after accounting for the association with potentially severe additional body system injuries.
骨盆环骨折是否为钝性创伤后死亡的独立预测因素尚不清楚。此前很少有研究试图分析与骨盆环损伤相关的高死亡率是继发于骨盆环损伤，还是仅仅与此类情况下通常会出现的许多其他损伤有关。我们的假设是，即使在考虑了其他相关损伤导致的死亡风险之后，骨盆环骨折仍是死亡的独立危险因素。
我们回顾了1995年至2002年期间在我们的一级创伤中心因钝性创伤就诊的31550例患者的记录。我们分析了前瞻性收集的数据库，并排除了任何缺少一项以上人口统计学参数的患者（n = 414，占数据集的1.3%）。我们的研究组包括1017例骨盆环骨折患者和30119例无骨盆环骨折的钝性创伤患者。进行多因素逻辑回归分析，以确定相关临床标准对死亡率的相对影响。然后通过回归分析设计一个死亡率模型，使我们能够比较研究组中每个患者的计算死亡几率。然后我们将骨盆损伤患者的预期死亡人数与该数据集中观察到的实际死亡人数进行比较。此外，我们进行了第二项统计分析，将骨盆环骨折人群（n = 1017）的死亡率与我们无骨盆环骨折患者人群（n = 30119）中匹配的亚组（n = 1017）的死亡率进行比较。
基于两种统计方法，骨盆环骨折的存在均被发现是钝性创伤人群死亡率的独立危险因素（优势比分别为1.9 [p < 0.001] 和2.1 [p < 0.0007]）。其他显著的死亡预测因素包括患者年龄、损伤严重度评分、格拉斯哥昏迷量表评分、入院时的收缩压和呼吸频率，以及几种内科合并症。
即使在考虑了与潜在严重的其他身体系统损伤的关联之后，骨盆环骨折的存在似乎仍是死亡率的一个具有临床意义的独立危险因素。
