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High-energy trauma patients with pelvic fractures: Management trends in Ontario, Canada
Although fractures of the pelvic ring account for only 2–3% of all fractures, they are present in approximately 7–20% of patients with high-energy polytrauma. High-energy pelvic fractures are life-threatening injuries, with mortality estimates ranging from 6 to 35%. The purpose of this study was to...
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| Published in: | Injury 2018-10, Vol.49 (10), p.1830-1840 |
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| container_title | Injury |
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| creator | Mann, Stephen M. Banaszek, Daniel Lajkosz, Katherine Brogly, Susan B. Stanojev, Shelby M. Evans, Chris Bardana, Davide D. Yach, Jeff Hall, Stephen |
| description | Although fractures of the pelvic ring account for only 2–3% of all fractures, they are present in approximately 7–20% of patients with high-energy polytrauma. High-energy pelvic fractures are life-threatening injuries, with mortality estimates ranging from 6 to 35%. The purpose of this study was to examine trends in the incidence, diagnosis, treatment, and mortality rates of high-energy pelvic fractures in Ontario, Canada over a 10-year period.
A cohort of 3915 patients who sustained a high-energy pelvic fracture in Ontario between 01 April 2005 and 31 March 2015 was identified using the Ontario Trauma Registry and administrative healthcare data linked by the Institute for Clinical Evaluative Science (ICES). Severely injured patients (defined as having an Injury Severity Score (ISS) of ≥16) with pelvic fractures following high-velocity mechanisms of injury were identified using applicable ICD-10 codes. Trends were assessed statistically using the Poisson and the Cochrane-Armitage tests for trend. Modified Poisson regression was used to model the adjusted risk ratio of mortality by pelvic fracture treatment.
The incidence of pelvic fracture remained constant at approximately 4.6 cases per 100,000 population annually between 2005 and 2011. From 2012, there was a decrease in patients with ISS ≥ 16 due to changes in the calculation of the ISS. The proportion of patients presenting with ISS > 50 increased from 8.2% to 14.1% (p = 0.008) over the study period. Automobile collisions or pedestrians struck by vehicles accounted for over half of injuries. Approximately 6% of patients underwent angioembolisation. Treatment with external fixation (15.5%–20.2%) or no surgical intervention (46.2%–61.3%) increased from 2005 to 2015. Mortality remained constant (11% at 30 days), and laparotomy was the only major intervention not associated with decreased risk of death.
Stable mortality despite increasing injury severity suggests that the quality of care provided to patients with high-energy pelvic fractures has improved over time. However, unchanged incidence suggests the need for ongoing efforts aimed towards injury prevention. ISS at presentation was the most significant predictor of mortality in this patient population. |
| doi_str_mv | 10.1016/j.injury.2018.06.044 |
| format | article |
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A cohort of 3915 patients who sustained a high-energy pelvic fracture in Ontario between 01 April 2005 and 31 March 2015 was identified using the Ontario Trauma Registry and administrative healthcare data linked by the Institute for Clinical Evaluative Science (ICES). Severely injured patients (defined as having an Injury Severity Score (ISS) of ≥16) with pelvic fractures following high-velocity mechanisms of injury were identified using applicable ICD-10 codes. Trends were assessed statistically using the Poisson and the Cochrane-Armitage tests for trend. Modified Poisson regression was used to model the adjusted risk ratio of mortality by pelvic fracture treatment.
The incidence of pelvic fracture remained constant at approximately 4.6 cases per 100,000 population annually between 2005 and 2011. From 2012, there was a decrease in patients with ISS ≥ 16 due to changes in the calculation of the ISS. The proportion of patients presenting with ISS > 50 increased from 8.2% to 14.1% (p = 0.008) over the study period. Automobile collisions or pedestrians struck by vehicles accounted for over half of injuries. Approximately 6% of patients underwent angioembolisation. Treatment with external fixation (15.5%–20.2%) or no surgical intervention (46.2%–61.3%) increased from 2005 to 2015. Mortality remained constant (11% at 30 days), and laparotomy was the only major intervention not associated with decreased risk of death.
Stable mortality despite increasing injury severity suggests that the quality of care provided to patients with high-energy pelvic fractures has improved over time. However, unchanged incidence suggests the need for ongoing efforts aimed towards injury prevention. ISS at presentation was the most significant predictor of mortality in this patient population.</description><identifier>ISSN: 0020-1383</identifier><identifier>EISSN: 1879-0267</identifier><identifier>DOI: 10.1016/j.injury.2018.06.044</identifier><identifier>PMID: 29997027</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Accident Prevention ; Accidents, Traffic - statistics & numerical data ; Adult ; Female ; Fractures, Bone - mortality ; Fractures, Bone - surgery ; Health Care Surveys ; High-energy trauma ; Humans ; Incidence ; Injury Severity Score ; Male ; Middle Aged ; Ontario ; Outcome Assessment (Health Care) ; Pelvic Bones - injuries ; Pelvic Bones - surgery ; Pelvic fractures ; Quality of Health Care - standards ; Trauma Centers - trends ; Treatment Outcome ; Young Adult</subject><ispartof>Injury, 2018-10, Vol.49 (10), p.1830-1840</ispartof><rights>2018 Elsevier Ltd</rights><rights>Copyright © 2018 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-9d712aa6973410502d45c6ad70405d552a5e401366b3c721a5597047ac7c4f023</citedby><cites>FETCH-LOGICAL-c362t-9d712aa6973410502d45c6ad70405d552a5e401366b3c721a5597047ac7c4f023</cites><orcidid>0000-0003-3760-5401 ; 0000-0002-0030-8588 ; 0000-0002-4711-8079</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29997027$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mann, Stephen M.</creatorcontrib><creatorcontrib>Banaszek, Daniel</creatorcontrib><creatorcontrib>Lajkosz, Katherine</creatorcontrib><creatorcontrib>Brogly, Susan B.</creatorcontrib><creatorcontrib>Stanojev, Shelby M.</creatorcontrib><creatorcontrib>Evans, Chris</creatorcontrib><creatorcontrib>Bardana, Davide D.</creatorcontrib><creatorcontrib>Yach, Jeff</creatorcontrib><creatorcontrib>Hall, Stephen</creatorcontrib><title>High-energy trauma patients with pelvic fractures: Management trends in Ontario, Canada</title><title>Injury</title><addtitle>Injury</addtitle><description>Although fractures of the pelvic ring account for only 2–3% of all fractures, they are present in approximately 7–20% of patients with high-energy polytrauma. High-energy pelvic fractures are life-threatening injuries, with mortality estimates ranging from 6 to 35%. The purpose of this study was to examine trends in the incidence, diagnosis, treatment, and mortality rates of high-energy pelvic fractures in Ontario, Canada over a 10-year period.
A cohort of 3915 patients who sustained a high-energy pelvic fracture in Ontario between 01 April 2005 and 31 March 2015 was identified using the Ontario Trauma Registry and administrative healthcare data linked by the Institute for Clinical Evaluative Science (ICES). Severely injured patients (defined as having an Injury Severity Score (ISS) of ≥16) with pelvic fractures following high-velocity mechanisms of injury were identified using applicable ICD-10 codes. Trends were assessed statistically using the Poisson and the Cochrane-Armitage tests for trend. Modified Poisson regression was used to model the adjusted risk ratio of mortality by pelvic fracture treatment.
The incidence of pelvic fracture remained constant at approximately 4.6 cases per 100,000 population annually between 2005 and 2011. From 2012, there was a decrease in patients with ISS ≥ 16 due to changes in the calculation of the ISS. The proportion of patients presenting with ISS > 50 increased from 8.2% to 14.1% (p = 0.008) over the study period. Automobile collisions or pedestrians struck by vehicles accounted for over half of injuries. Approximately 6% of patients underwent angioembolisation. Treatment with external fixation (15.5%–20.2%) or no surgical intervention (46.2%–61.3%) increased from 2005 to 2015. Mortality remained constant (11% at 30 days), and laparotomy was the only major intervention not associated with decreased risk of death.
Stable mortality despite increasing injury severity suggests that the quality of care provided to patients with high-energy pelvic fractures has improved over time. However, unchanged incidence suggests the need for ongoing efforts aimed towards injury prevention. ISS at presentation was the most significant predictor of mortality in this patient population.</description><subject>Accident Prevention</subject><subject>Accidents, Traffic - statistics & numerical data</subject><subject>Adult</subject><subject>Female</subject><subject>Fractures, Bone - mortality</subject><subject>Fractures, Bone - surgery</subject><subject>Health Care Surveys</subject><subject>High-energy trauma</subject><subject>Humans</subject><subject>Incidence</subject><subject>Injury Severity Score</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Ontario</subject><subject>Outcome Assessment (Health Care)</subject><subject>Pelvic Bones - injuries</subject><subject>Pelvic Bones - surgery</subject><subject>Pelvic fractures</subject><subject>Quality of Health Care - standards</subject><subject>Trauma Centers - trends</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0020-1383</issn><issn>1879-0267</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kE1v1DAQhi0EotvCP0DIRw4kjD9iJxyQqhW0SEW9gDhaU3t269UmWWynaP89rrZw5DSHed75eBh7I6AVIMyHXRun3ZKOrQTRt2Ba0PoZW4neDg1IY5-zFYCERqhenbHznHcAwoJSL9mZHIbBgrQr9vM6bu8bmihtj7wkXEbkByyRppL571ju-YH2D9HzTUJflkT5I_-GE25prEhN0BQyjxO_nQqmOL_n69oN-Iq92OA-0-unesF-fPn8fX3d3NxefV1f3jReGVmaIVghEc1glRbQgQy68waDBQ1d6DqJHWkQypg75a0U2HX1cG3RW683INUFe3eae0jzr4VycWPMnvZ7nGhespNg-kFokH1F9Qn1ac450cYdUhwxHZ0A96jU7dxJqXtU6sC4qrTG3j5tWO5GCv9Cfx1W4NMJoPrnQ6Tksq_-PIWYyBcX5vj_DX8AaHOIqA</recordid><startdate>201810</startdate><enddate>201810</enddate><creator>Mann, Stephen M.</creator><creator>Banaszek, Daniel</creator><creator>Lajkosz, Katherine</creator><creator>Brogly, Susan B.</creator><creator>Stanojev, Shelby M.</creator><creator>Evans, Chris</creator><creator>Bardana, Davide D.</creator><creator>Yach, Jeff</creator><creator>Hall, Stephen</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3760-5401</orcidid><orcidid>https://orcid.org/0000-0002-0030-8588</orcidid><orcidid>https://orcid.org/0000-0002-4711-8079</orcidid></search><sort><creationdate>201810</creationdate><title>High-energy trauma patients with pelvic fractures: Management trends in Ontario, Canada</title><author>Mann, Stephen M. ; Banaszek, Daniel ; Lajkosz, Katherine ; Brogly, Susan B. ; Stanojev, Shelby M. ; Evans, Chris ; Bardana, Davide D. ; Yach, Jeff ; Hall, Stephen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-9d712aa6973410502d45c6ad70405d552a5e401366b3c721a5597047ac7c4f023</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Accident Prevention</topic><topic>Accidents, Traffic - statistics & numerical data</topic><topic>Adult</topic><topic>Female</topic><topic>Fractures, Bone - mortality</topic><topic>Fractures, Bone - surgery</topic><topic>Health Care Surveys</topic><topic>High-energy trauma</topic><topic>Humans</topic><topic>Incidence</topic><topic>Injury Severity Score</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Ontario</topic><topic>Outcome Assessment (Health Care)</topic><topic>Pelvic Bones - injuries</topic><topic>Pelvic Bones - surgery</topic><topic>Pelvic fractures</topic><topic>Quality of Health Care - standards</topic><topic>Trauma Centers - trends</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mann, Stephen M.</creatorcontrib><creatorcontrib>Banaszek, Daniel</creatorcontrib><creatorcontrib>Lajkosz, Katherine</creatorcontrib><creatorcontrib>Brogly, Susan B.</creatorcontrib><creatorcontrib>Stanojev, Shelby M.</creatorcontrib><creatorcontrib>Evans, Chris</creatorcontrib><creatorcontrib>Bardana, Davide D.</creatorcontrib><creatorcontrib>Yach, Jeff</creatorcontrib><creatorcontrib>Hall, Stephen</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Injury</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mann, Stephen M.</au><au>Banaszek, Daniel</au><au>Lajkosz, Katherine</au><au>Brogly, Susan B.</au><au>Stanojev, Shelby M.</au><au>Evans, Chris</au><au>Bardana, Davide D.</au><au>Yach, Jeff</au><au>Hall, Stephen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High-energy trauma patients with pelvic fractures: Management trends in Ontario, Canada</atitle><jtitle>Injury</jtitle><addtitle>Injury</addtitle><date>2018-10</date><risdate>2018</risdate><volume>49</volume><issue>10</issue><spage>1830</spage><epage>1840</epage><pages>1830-1840</pages><issn>0020-1383</issn><eissn>1879-0267</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Although fractures of the pelvic ring account for only 2–3% of all fractures, they are present in approximately 7–20% of patients with high-energy polytrauma. High-energy pelvic fractures are life-threatening injuries, with mortality estimates ranging from 6 to 35%. The purpose of this study was to examine trends in the incidence, diagnosis, treatment, and mortality rates of high-energy pelvic fractures in Ontario, Canada over a 10-year period.
A cohort of 3915 patients who sustained a high-energy pelvic fracture in Ontario between 01 April 2005 and 31 March 2015 was identified using the Ontario Trauma Registry and administrative healthcare data linked by the Institute for Clinical Evaluative Science (ICES). Severely injured patients (defined as having an Injury Severity Score (ISS) of ≥16) with pelvic fractures following high-velocity mechanisms of injury were identified using applicable ICD-10 codes. Trends were assessed statistically using the Poisson and the Cochrane-Armitage tests for trend. Modified Poisson regression was used to model the adjusted risk ratio of mortality by pelvic fracture treatment.
The incidence of pelvic fracture remained constant at approximately 4.6 cases per 100,000 population annually between 2005 and 2011. From 2012, there was a decrease in patients with ISS ≥ 16 due to changes in the calculation of the ISS. The proportion of patients presenting with ISS > 50 increased from 8.2% to 14.1% (p = 0.008) over the study period. Automobile collisions or pedestrians struck by vehicles accounted for over half of injuries. Approximately 6% of patients underwent angioembolisation. Treatment with external fixation (15.5%–20.2%) or no surgical intervention (46.2%–61.3%) increased from 2005 to 2015. Mortality remained constant (11% at 30 days), and laparotomy was the only major intervention not associated with decreased risk of death.
Stable mortality despite increasing injury severity suggests that the quality of care provided to patients with high-energy pelvic fractures has improved over time. However, unchanged incidence suggests the need for ongoing efforts aimed towards injury prevention. ISS at presentation was the most significant predictor of mortality in this patient population.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>29997027</pmid><doi>10.1016/j.injury.2018.06.044</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-3760-5401</orcidid><orcidid>https://orcid.org/0000-0002-0030-8588</orcidid><orcidid>https://orcid.org/0000-0002-4711-8079</orcidid></addata></record> |
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| subjects | Accident Prevention Accidents, Traffic - statistics & numerical data Adult Female Fractures, Bone - mortality Fractures, Bone - surgery Health Care Surveys High-energy trauma Humans Incidence Injury Severity Score Male Middle Aged Ontario Outcome Assessment (Health Care) Pelvic Bones - injuries Pelvic Bones - surgery Pelvic fractures Quality of Health Care - standards Trauma Centers - trends Treatment Outcome Young Adult |
| title | High-energy trauma patients with pelvic fractures: Management trends in Ontario, Canada |
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