[Impact of a trauma network on mortality in patients with severe pelvic trauma]

Abstract

Aim: To evaluate the impact of a regional trauma network on intra-hospital mortality rates of patients admitted with severe pelvic trauma.

Study: Retrospective observational study.

Patients: Sixty-five trauma patients with serious pelvic fracture (pelvic abbreviated injury scale [AIS] score of 3 or more).

Methods: Demographic, physiologic and biological parameters were recorded. Observed mortality rates were compared to predicted mortality according to the Trauma Revised Injury Severity Score methodology adjusted by a case mix variation model.

Results: Twenty-nine patients were admitted in a level I trauma centre (reference centre) and 36 in level II trauma centres (centres with interventional radiology facility and/or neurosurgery). Patients from the level I trauma centre were more severely injured than those who were admitted at the level II trauma centres (Injury Severity Score [ISS]: 30 [13-75] vs 22 [9-59]; P<0.01). Time from trauma to hospital admission was also longer in level I trauma centre (115 [50-290] min vs 90 [28-240] min, P <0.01). Observed mortality rates (14%; 95% confidence interval, 95% CI, [1-26%]) were lower than the predicted mortality (29%; 95% CI [13-44%]) in the level I trauma centre. No difference in mortality rates was found in the level II trauma centres.

Conclusion: The regional trauma network could screen the most severely injured patients with pelvic trauma to admit them at a level I trauma centre. The observed mortality of these patients was lower than the predicted mortality despite increased time from trauma to admission.

Keywords: Mortality; Mortalité; Multiple trauma; Pelvic trauma; Polytraumatisme; Réseau de soins; Trauma network; Traumatisme du bassin.