Haws Brittany E, Wuertzer Scott, Raffield Laura, Lenchik Leon, Miller Anna N
Brittany E Haws, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
World J Orthop. 2016 Aug 18;7(8):481-6. doi: 10.5312/wjo.v7.i8.481.
To determine the association of unstable pelvic ring injuries with trauma code status.
A retrospective review of all pelvic ring injuries at a single academic center from July 2010 to June 2013 was performed. The trauma registry was used to identify level 1 and level 2 trauma codes for each injury. The computed tomography scans in all patients were classified as stable or unstable using the Abbreviated Injury Scale. Pelvic injury classifications in level 1 and level 2 groups were compared. Patient disposition at discharge in level 1 and level 2 groups were also compared.
There were 108 level 1 and 130 level 2 blunt trauma admissions. In the level 1 group, 67% of pelvic injuries were classified as stable fracture patterns and 33% were classified as unstable. In the level 2 group, 62% of pelvic injuries were classified as stable fracture patterns and 38% were classified as unstable. level 1 trauma code was not associated with odds of having an unstable fracture pattern (OR = 0.83, 95%CI: 0.48-1.41, P = 0.485). In the level 1 group with unstable pelvic injuries, 33% were discharged to home, 36% to a rehabilitation facility, and 32% died. In the level 2 group with unstable pelvic injuries, 65% were discharged to home, 31% to a rehabilitation facility, and 4% died. For those with unstable pelvic fractures (n = 85), assignment of a level 2 trauma code was associated with reduced odds of death (OR = 0.07, 95%CI: 0.01-0.35, P = 0.001) as compared to being discharged to home.
Trauma code level assignment is not correlated with severity of pelvic injury. Because an unstable pelvis can lead to hemodynamic instability, these injuries may be undertriaged.
确定不稳定骨盆环损伤与创伤编码状态之间的关联。
对2010年7月至2013年6月在单一学术中心的所有骨盆环损伤进行回顾性研究。使用创伤登记系统确定每次损伤的1级和2级创伤编码。所有患者的计算机断层扫描根据简明损伤量表分类为稳定或不稳定。比较1级和2级组的骨盆损伤分类。还比较了1级和2级组出院时的患者处置情况。
有108例1级钝性创伤入院患者和130例2级钝性创伤入院患者。在1级组中，67%的骨盆损伤被分类为稳定骨折类型，33%被分类为不稳定骨折类型。在2级组中，62%的骨盆损伤被分类为稳定骨折类型，38%被分类为不稳定骨折类型。1级创伤编码与不稳定骨折类型的几率无关（OR = 0.83，95%CI：0.48 - 1.41，P = 0.485）。在伴有不稳定骨盆损伤的1级组中，33%出院回家，36%转至康复机构，32%死亡。在伴有不稳定骨盆损伤的2级组中，65%出院回家，31%转至康复机构，4%死亡。对于伴有不稳定骨盆骨折的患者（n = 85），与出院回家相比，2级创伤编码的分配与死亡几率降低相关（OR = 0.07，95%CI：0.01 - 0.35，P = 0.001）。
创伤编码级别分配与骨盆损伤的严重程度无关。由于不稳定骨盆可导致血流动力学不稳定，这些损伤可能未得到充分分诊。
