Fri., 10/14/11 Pelvis & Spine, Paper #46, 10:46 am OTA-2011
The Importance of Trauma Center Care on Mortality and Function Following Pelvic Ring and Acetabular Injuries
Saam Morshed, MD, PhD, MPH1; Gregory J. Jurkovich, MD2; Jin Wang, PhD2;
Simon Knops, MD1; Frederick P. Rivara, MD, MPH2;
1University of California San Francisco, San Francisco, California, USA;
2University of Washington School of Medicine, Seattle, Washington, USA
Purpose: Lower mortality and improved physical function following major polytrauma has been associated with treatment at Level 1 trauma centers compared with that at nontrauma centers. The purpose of this study was to investigate the impact of trauma center care on outcomes after pelvic injuries, recognizing that these results could have important implications for appropriate triage of these severely injured patients.
Methods: Mortality and quality of life–related measures were compared among patients treated in 18 hospitals with Level 1 trauma centers and 51 hospitals without trauma centers in 14 states. Complete data were obtained on 829 adult trauma patients (18-84 years of age) with at least one pelvic ring or acetabular injury (OTA 61 or 62). We used inverse probability of treatment weighting to adjust for observable confounding between patients treated at trauma centers versus those treated at nontrauma centers.
Results: After adjustment for case mix, inhospital mortality was significantly lower at trauma centers versus nontrauma centers (relative risk [RR] 0.10; 95% confidence interval [CI], 0.02-0.47), as was death by 90 days (RR 0.10; 95% CI, 0.02-0.47), and 1 year (RR 0.21; 95% CI, 0.06-0.76) for patients with more severe acetabular injuries (OTA 62-B and 62-C). Patients with combined pelvic ring and acetabular injuries treated at trauma centers had lower mortality by 90 days (RR 0.34; 95% CI, 0.14-0.82) and 1 year (RR 0.30; 95% CI, 0.14-0.68). Average differences in Short Form-36 physical functioning and Musculoskeletal Functional Assessment at 1 year were 11.4 (95% CI, 5.3-17.4) and 13.2 (1.7-24.7) respectively, indicating statistically and clinically significant improved outcomes with treatment at trauma centers for more severe acetabular injuries.
Conclusions: Our findings show that risk of mortality is significantly lower for patients with severe acetabular injuries and that these patients also enjoy improved physical functioning at 1 year when care is provided in a trauma center than in a nontrauma center. Patients with severe acetabular injuries and any combined acetabular and other pelvic ring injuries should be triaged to trauma centers.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.