Comparison of the Mortality Rate according to the Presence of Trauma Team in Hemodynamically Unstable Patients with Pelvic Ring Injury

Ji Wan Kim; Suk-Kyung Hong; Kyu Hyouck Kyoung; Ji Ho Choi; Jung Jae Kim

doi:10.4055/jkoa.2012.47.3.191

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Kim, Hong, Kyoung, Choi, and Kim: Comparison of the Mortality Rate according to the Presence of Trauma Team in Hemodynamically Unstable Patients with Pelvic Ring Injury

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(3): 191-197.

Published online: 26 June 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.3.191

Comparison of the Mortality Rate according to the Presence of Trauma Team in Hemodynamically Unstable Patients with Pelvic Ring Injury

Ji Wan Kim, M.D., Suk-Kyung Hong, M.D.^*, Kyu Hyouck Kyoung, M.D.^†, Ji Ho Choi, M.D.^‡, Jung Jae Kim, M.D.^‡

Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

^*Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

^†Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

^‡Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to: Jung Jae Kim, M.D. Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. TEL: +82-2-3010-3538, FAX: +82-2-488-7877, jjkim2@amc.seoul.kr

Received 10 August 2011 Revised 21 October 2011 Accepted 29 October 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the clinical results of hemodynamically unstable patients diagnosed with pelvic ring injury according to the presence of a trauma team.

Materials and Methods

Patients with hemodynamically unstable pelvic fracture were enrolled in the study and were divided into two groups: Group I, patients who were managed before March 2009, when there was no trauma team; and Group II, patients who were managed after March 2009, when emergent trauma team began to work. Data were collected regarding the time the trauma team began patient management, the treatment modality used to control bleeding, transfusion requirement, and patient mortality.

Results

The time when the trauma team began patient management was five hours and 48 minutes in Group I and 57 minutes in Group II. The time to definitive treatment in order to control bleeding in Group I and Group II was 14.4 hours and 4.2 hours, respectively. The amount of the transfusion was 41.1 unit in Group I and 13.2 unit in Group II patients. In Group I, four patients (57.1%) died, although only one of the seven patients in Group II (14.3%) died.

Conclusion

Using a multidisciplinary approach, the trauma team has only a short amount of time to determine their treatment strategy and to achieve prompt management of bleeding, with the final objective to decrease the mortality rate in patients with hemodynamically unstable pelvic fractures.

Keywords: trauma, pelvic fracture injury, mortality, trauma team

Figures and Tables

Figure 1

Comparison of treatment modality to control bleeding between the two groups. EF, external fixation; Emb, embolization.

Figure 2

(A) Plain radiograph of a 42-year-old male shows vertical shear type of pelvic ring injury due to falling down from 9 meters high. Initial blood pressure was 79/33 mmHg at 30 minutes after trauma. (B) External fixation for anterior ring and percutaneous iliosacral screw fixation were done 5 hours after arrival and the vital sign was finally stabilized.

Figure 3

(A) Plain radiograph of a 43-year-old male shows combined mechanism type of pelvic ring injury due to falling down from 7 meters high. He was transferred to emergency room (ER) 7 hours after trauma. On arrival at ER, blood pressure was 44/30 mmHg and mental state was semi-coma state. (B) Angiography reveals extravasation of contrast at the internal iliac artery and branch of lumbar artery. Embolization in the past 3 hours made mental status alert but blood pressure was 91/76 mmHg with heart rate of 127 per minutes. (C) External fixation for anterior ring and percutaneous iliosacral screw fixation were done 11 hours after arrival and the vital sign was stabilized at last.

Figure 4

Comparison of clinical results between the two groups.

Table 1

Characteristics of Hemodynamically Unstable Patients with Pelvic Ring Injury

^*Injury Severity Score; ^†motor vehicle accident; ^‡industrial mishap; ^§pedestrian traffic accident; ^∥anterposterior compression; ^¶vertical shear; ^**combined mechanism; ^††external fixation; ^‡‡embolization. M, male; F, female.

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