Mejora de la supervivencia después de la fractura pélvica: Experiencia de 13 años en un centro de trauma individual mediante un protocolo institucional multidisciplinario /Improved Survival After Pelvic Fracture: 13 Year Experience at a Single Trauma Center Using a Multi-disciplinary Institutional Protocol

Fuente
Este artículo es originalmente publicado en:

http://www.ncbi.nlm.nih.gov/pubmed/26360539

http://journals.lww.com/jorthotrauma/Abstract/publishahead/Improved_Survival_After_Pelvic_Fracture___13_Year.99094.aspx
De:

Black SR1, Sathy AK, Jo C, Wiley MR, Minei JP, Starr AJ.

J Orthop Trauma. 2015 Sep 3. [Epub ahead of print]
Todos los derechos reservados para:

Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.

 

Abstract

OBJECTIVES:

To analyze pelvic fracture mortality rates before and after initiation of a multi-disciplinary pelvic fracture protocol.

DESIGN:

Retrospective database analysis SETTING:: Prospective data from our Level-I National Trauma Registry of The American College of Surgeons (NTRACS) database.

PATIENTS/PARTICIPANTS:

A total of 1682 trauma patients with pelvic fractures from 2000-2013 were compared with a control group of 42,629 without pelvic fractures.

INTERVENTION:

Initiation of a multi-disciplinary institutional protocol to guide the initial management of trauma patients with pelvic fractures MAIN OUTCOME MEASUREMENTS:: Patients were grouped into three periods (Group 1: 2000 – 2003, Group 2: 2004 – 2007, Group 3: 2008 – 2013). Multivariate logistic regression analysis was conducted to assess associations between mortality and age, shock (systolic blood pressure (SBP) less than or equal to 90 mmHg), head injury (Glasgow Coma Scale (GCS) less than or equal to 8), Injury Severity Score (ISS), and time period.

RESULTS:

Unadjusted mortality rates decreased (12.5% to 11.0%(p=0.72)) while ISS increased (19.1 to 22.7(p<0.01)). Age, shock, head injury, increasing ISS, and earlier time period were significantly associated with mortality. Adjusted mortality decreased over time (odds ratio (OR) for 2000-2003 versus 2008-2013: 2.05, 95% confidence interval (CI)=(1.26, 3.33) and OR for 2004-2007 versus 2008-2013: 1.71, 95%CI=(1.09, 2.67)). From 2000-2003, an unstable fracture pattern in the healthiest cohort significantly increased mortality compared to the stable fracture pattern cohort (8.6% and 0.0%, P<0.01). In subsequent intervals there was no statistically significant association between stable versus unstable fracture patterns andmortality.

CONCLUSIONS:

Adjusted pelvic fracture mortality rates have significantly decreased over time. In the healthiest patients with unstable pelvicfractures, the mortality rate is now similar to that of patients with stable fracture patterns. With sustained institutional effort to address pelvicfractures, mortality rates can be diminished.

LEVEL OF EVIDENCE:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID: 26360539 [PubMed – as supplied by publisher]

 

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