Demography, emergency interventions and outcome after severe pelvic injuries: a two-decade registry study from South- Western Norway.

BACKGROUND

Severe pelvic injuries with ISS > 15 is associated with a high degree of morbidity and mortality. We aimed to describe the demography, emergency interventions and outcome of patients with these injuries and analyze changes in practice occurring in this timeframe.

METHODS

Stavanger University Hospital (SUH) is located in South-Western Norway. All patients registered in the Stavanger University Hospital Trauma registry between 2004-2022 with a pelvic injury and concomitant ISS > 15 were included in this study.

RESULTS

In total 2283 patients with a pelvic injury were included in the trauma registry between 2004-2022. There were 160 patients with an ISS > 15, with 115 (72%) men and 45 (28%) women. Median age of men was 45 years, while women were slightly older at 52 years of age. The 30-day mortality in men (25/115) and women (10/45) was identical at 22%. Emergency intervention was performed in 33/160 (20.1%%) patients. In 27 patients a laparotomy, an EPP or an angioembolization was the primary hemostatic emergency procedure. All but one pelvic packing were done in the years 2010-2014, with one packing also performed in 2021. A significant decline both in number of patients receiving crystalloids and the amount of crystalloids administered, both prehospitally and in the ER were seen when comparing period 1-3. The mortality in the EPP group was very high at 6/8 (75%) while only 1/9 in the laparotomy group succumbed and 2/10 (20%) in the AE group. These discrepancies may be related to the high median ISS of 50 in the pelvic packing group, vs 40 in the angioembolization group vs 38 in the laparotomy group, reflected by a statistically significant difference in probability of survival (TRISS score) between emergency intervention groups (p < 0.001).

CONCLUSION

Severe pelvic injuries are quite rare, with about 1 incident per month. About 2/3 are men and transport related injuries are the most common mechanism of injury. Patients in need of emergency intervention are characterized by a high median ISS and concomitant high mortality. A significant decline in emergency interventions were seen over time, which may be related to declining infusions of crystalloids and better transfusion protocols.