Session VII - Pelvis
Decreased Mortality among Pelvic Fracture Patients: The Effect of a Pelvic Fracture Management Protocol Emphasizing Pelvic Binders and Early Arteriography
Purpose: This study was conducted to evaluate a protocol's ability to improve mortality among pelvic fracture patients at high risk for death.
Methods: A review of pelvic fracture patients treated between 1997 and 1999 revealed 3 groups at high risk for death: elderly patients, patients with unstable fracture patterns, and patients in hemodynamic shock. A protocol that emphasized rapid stabilization with pelvic binders and early use of arteriographic embolization was developed and implemented. Data collection for this study began July 1, 2004 (after care providers had become familiar and compliant with the protocol) and was continued until November 2005. Triggers for activation were: (1) age >54, (2) hemodynamic shock on arrival (systolic blood pressure <100 mm Hg), or (3) unstable fracture pattern (APC2, APC3, LC3, VS). Mortality rates in the 3 high-risk categories treated under the protocol was compared to that reported in the 1997-1999 period, when a protocol was not in place, using a one sample proportions test with a 2-sided null hypothesis.
Results: Before protocol implementation, 21 of 44 patients (48%) in shock died, whereas 7 of 25 (28%) in shock died after implementation, a 41% drop in mortality (P = 0.0483). 18 of 77 (23%) patients with unstable fractures died before protocol implementation, whereas 11 of 66 (17%) with unstable fractures died after implementation, a 26% drop in mortality (P = 0.0191)
12 of 49 patients (24%) over age of 54 died before protocol implementation, whereas 11 of 67 (16%) over age 54 died after implementation, a 33% drop in mortality (P = 0.1244).
Conclusion/Significance: The protocol's ability to decrease mortality among patients who present in hemodynamic shock and those with unstable pelvic fractures the groups at greatest risk for death was significant.