Auditing 655 fatalities with pelvic fractures by autopsy as a basis to evaluate trauma care

J Am Coll Surg. 2006 Jul;203(1):30-43. doi: 10.1016/j.jamcollsurg.2006.03.017. Epub 2006 May 30.


Background: To determine the role of pelvic fractures in auditing mortality resulting from trauma.

Study design: This retrospective case-control study based on autopsy-evaluated circumstances of the deaths of patients with pelvic fractures.

Results: Of 2,583 patients injured in motor-vehicle collisions, 655 (25.4%) constituted the pelvic fracture (PFx) group, and 1,928 (74.6%) constituted the control group. One-third of the PFx group's fatalities had an Injury Severity Score (ISS) of 75 and were not preventable. The PFx group had a substantially higher median ISS than the control group (50 versus 34; p < 0.0001). Four hundred fifty-four patients (69.3%) in the PFx group with ISS 16 to 74 had substantially higher rates of associated injuries. Nearly half of the PFx group patients with ISS <or= 74 had a potential cause of major hemorrhage other than pelvic fracture. Twenty-three (3.5%) deaths were directly attributable to pelvic fractures. Postinjury median survival time was 55 minutes for the PFx group and 100 minutes for the control group (p < 0.0001). The time limit for management of the patients with pelvic fractures was short, as 527 (81.5%) died in the first 6 hours. It was evident that the more severe the injuries were, the sooner the deaths occurred. Of 151 subjects who left the emergency department alive, 61.6% were subjected to operation and 48.3% to abdominal operation.

Conclusions: Pelvic fracture is an indicator of severe multiple trauma, but a small proportion of deaths are directly attributable to pelvic fracture. A method based on autopsy audited patients with pelvic fractures as a paradigm of injury revealed that pelvic fracture is an important injury to consider in auditing trauma care and indicated several issues that should be considered to reduce mortality.

MeSH terms

  • Accidents, Traffic / mortality*
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Autopsy*
  • Cause of Death
  • Child
  • Child, Preschool
  • Female
  • Fractures, Bone / mortality*
  • Fractures, Bone / pathology
  • Fractures, Bone / therapy
  • Greece
  • Humans
  • Infant
  • Male
  • Medical Audit / methods*
  • Middle Aged
  • Pelvic Bones / injuries*
  • Retrospective Studies
  • Traumatology*