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. 2017 Nov 9;17(1):104.
doi: 10.1186/s12893-017-0299-6.

Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study

Fabio Agri  1   2 , Mylène Bourgeat  1 , Fabio Becce  3 , Kevin Moerenhout  4 , Mathieu Pasquier  2 , Olivier Borens  4 , Bertrand Yersin  2 , Nicolas Demartines  5 , Tobias Zingg  1
Affiliations

Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study

Fabio Agri et al. BMC Surg. .

Abstract

Background: Pelvic fractures are severe injuries with frequently associated multi-system trauma and a high mortality rate. The value of the pelvic fracture pattern for predicting transfusion requirements and mortality is not entirely clear. To address hemorrhage from pelvic injuries, the early application of pelvic binders is now recommended and arterial angio-embolization is widely used for controlling arterial bleeding. Our aim was to assess the association of the pelvic fracture pattern according to the Tile classification system with transfusion requirements and mortality rates, and to evaluate the correlation between the use of pelvic binders and arterial angio-embolization and the mortality of patients with pelvic fractures.

Methods: Single-center retrospective cohort study including all consecutive patients with a pelvic fracture from January 2008 to June 2015. All radiological fracture patterns were independently reviewed and grouped according to the Tile classification system. Data on patient demographics, use of pelvic binders and arterial angio-embolization, transfusion requirements and mortality were extracted from the institutional trauma registry and analyzed.

Results: The present study included 228 patients. Median patient age was 43.5 years and 68.9% were male. The two independent observers identified 105 Tile C (46.1%), 71 Tile B (31.1%) and 52 Tile A (22.8%) fractures, with substantial to almost perfect interobserver agreement (Kappa 0.70-0.83). Tile C fractures were associated with a higher mortality rate (p = 0.001) and higher transfusion requirements (p < 0.0001) than Tile A or B fractures. Arterial angio-embolization for pelvic bleeding (p = 0.05) and prehospital pelvic binder placement (p = 0.5) were not associated with differences in mortality rates.

Conclusions: Tile C pelvic fractures are associated with higher transfusion requirements and a higher mortality rate than Tile A or B fractures. No association between the use of pelvic binders or arterial angio-embolization and survival was observed in this cohort of patients with pelvic fractures.

Keywords: Arterial angio-embolization; Circumferential compression device; Mortality; Packed red blood cell transfusion; Pelvic fracture classification.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the Lausanne University Hospital’s institutional review board (Protocol No 2016-00927).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Boxplot diagrams showing median PRBC transfusion requirements for patients with Tile a (0 units; IQR, 0-0), b (0 units; IQR, 0-0) and c (1 unit; IQR, 0-7; p < 0.0001) fractures. PRBC = Packed Red Blood Cells
Fig. 2
Fig. 2
Forest plot showing factors associated with 48-h mortality after multivariate analysis. CI = Confidence interval, OR = Odds ratio, PRBC = Packed Red Blood Cells
See this image and copyright information in PMC

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