Open AccessPositive impact of trauma center to exsanguinating pelvic bone fracture patient survival: A Korean trauma center study
Author(s) -
Lee Mina,
Yu Byungchul,
Lee Giljae,
Lee Jungnam,
Choi Kangkook,
Park Youngeun,
Gwak Jihun,
Jang Myung Jin
Publication year - 2023
Publication title -
hong kong journal of emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.145
H-Index - 12
eISSN - 2309-5407
pISSN - 1024-9079
DOI - 10.1177/10249079221087799
Subject(s) - medicine , trauma center , pelvic fracture , major trauma , surgery , injury severity score , logistic regression , occlusion , retrospective cohort study , emergency medicine , pelvis , poison control , injury prevention
Background: Trauma center and multidisciplinary management protocols have been proven to improve the outcomes of severely injured patients. Hemorrhage from pelvic injury is associated with high mortality and is a common cause of preventable trauma death. This study aimed to evaluate the effects of the establishment of a trauma center and management protocols on the outcomes of hemodynamically unstable patients with pelvic fractures. Methods: Hemodynamically unstable patients with pelvic fractures were reviewed retrospectively over a 10‐year period. They were grouped into the pre‐phase and post‐phase, which were defined as before and after the establishment of a trauma center and protocols, respectively. Basic characteristics and outcomes were compared between periods. Results: This study enrolled a total of 106 patients. Basic and physiological characteristics were not significantly different in both phases. Pre‐peritoneal packing and resuscitative endovascular balloon occlusion of aorta were only performed in the post‐phase (pre‐peritoneal packing, N = 27; resuscitative endovascular balloon occlusion of aorta, N = 10). In the post‐phase, the time from emergency department arrival to hemostatic intervention was significantly shorter (269 ± 132.4 min vs 147.2 ± 95.5 min, p < 0.0001), and mortality due to acute hemorrhage was significantly lower (p = 0.003; absolute risk reduction: 0.22; relative risk reduction: 0.72). Multivariate logistic regression analysis identified age, injury severity score, and the pre‐phase as independent risk factors for mortality. Conclusion: The establishment of a trauma center and multidisciplinary management protocols, such as pre‐peritoneal packing and resuscitative endovascular balloon occlusion of aorta, improved the outcomes of hemodynamically unstable patients with pelvic fractures.