Pelvic fractures: Epidemiology and predictors of associated abdominal injuries and outcomes
Pelvic fractures: Epidemiology and predictors of associated abdominal injuries and outcomes
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DOI：
10.1016/s1072-7515(02)01197-3
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发表时间：
2002-07-01
影响因子：
5.2
通讯作者：
Chan, L
中科院分区：
文献类型：
--
作者：
Demetriades, D;Karaiskakis, M;Chan, L
背景：骨盆骨折常与严重的腹腔内损伤或骨折部位的严重出血相关。
目的：研究骨盆骨折的流行病学，并确定相关腹部损伤、出血、需要血管造影栓塞以及死亡的重要危险因素。
方法：对钝性创伤所致骨盆骨折进行创伤登记研究。采用逐步逻辑回归分析来确定严重骨盆骨折、相关腹部损伤、需要大量输血、治疗性栓塞以及骨盆骨折死亡的危险因素。得出调整后的相对风险和95%置信区间。
结果：共有16630例钝性创伤的创伤登记患者，其中1545例（9.3%）有骨盆骨折。腹部损伤的发生率为16.5%，最常见的受伤器官是肝脏（6.1%）以及膀胱和尿道（5.80%）。在严重骨盆骨折（简略损伤量表[AIS]≥4）中，相关腹腔内损伤的发生率为30.7%，最常见的受伤器官是膀胱和尿道（14.6%）。在所研究的危险因素中，机动车碰撞是与严重骨盆骨折呈负相关的唯一显著危险因素。相关肝脏损伤的主要危险因素是机动车碰撞和骨盆AIS≥4。大量失血的危险因素是年龄>16岁、骨盆AIS≥4、血管造影栓塞以及损伤严重程度评分（ISS）>25。年龄>55岁是相关主动脉损伤的唯一预测因素。与治疗性血管造影栓塞相关的因素是骨盆AIS为4以及ISS>25。总体死亡率为13.5%，但仅有0.8%是骨盆骨折的直接结果导致死亡。与死亡率相关的唯一显著危险因素是ISS>25。
结论：一些流行病学变量是骨盆骨折严重程度、相关腹部损伤的存在、失血以及需要血管造影的重要危险因素。这些危险因素有助于选择最恰当的诊断和治疗干预措施。
BACKGROUND: Pelvic fractures are often associated with major intraabdominal injuries or severe bleeding from the fracture site.OBJECTIVE: To study the epidemiology of pelvic fractures and identify important risk factors for associated abdominal injuries, bleeding, need for angiographic embolization, and death.METHODS: Trauma registry study on pelvic fractures from blunt trauma. Stepwise logistic regression was used to identify risk factors of severe pelvic fractures, associated abdominal injuries, need for major blood transfusion, therapeutic embolization, and death from pelvic fracture. Adjusted relative risks and 95% confidence intervals were derived.RESULTS: There were 16,630 trauma registry patients with blunt trauma, of whom 1,545 (9.3%) had a pelvic fracture. The incidence of abdominal injuries was 16.5%, and the most common injured organs were the liver (6.1%) and the bladder and urethra (5.80%). In severe pelvic fractures (Abbreviated Injury Scale [AIS] greater than or equal to 4), the incidence of associated intraabdominal injuries was 30.7%, and the most commonly injured organs were the bladder and urethra (14.6%). Among the risk factors studied, motor vehicle crash is the only notable risk factor negatively associated with severe pelvic fracture. Major risk factors for associated liver injury were motor vehicle crash and pelvis AIS greater than or equal to 4. Risk factors of major blood loss were age > 16 years, pelvic AIS greater than or equal to 4, angiographic embolization, and Injury Severity Score (ISS) > 25. Age > 55 years was the only predictor for associated aortic injury. Factors associated with therapeutic angiographic embolization were pelvic AIS 4 and ISS > 25. The overall mortality was 13.5%, but only 0.8% died as a direct result of pelvic fracture. The only pronounced risk factor associated with mortality was ISS > 25.CONCLUSIONS: Some epidemiological variables are important risk factors of severity of pelvic fractures, presence of associated abdominal injuries, blood loss, and need of angiography. These risk factors can help in selecting the most appropriate diagnostic and therapeutic Interventions.