Management and outcomes of severe pelvic fractures in level I and II ACS verified trauma centers

Dominik A Jakob; Elizabeth R Benjamin; Camilla Cremonini; Demetrios Demetriades

doi:10.1016/j.amjsurg.2020.10.031

Management and outcomes of severe pelvic fractures in level I and II ACS verified trauma centers

Am J Surg. 2021 Jul;222(1):227-233. doi: 10.1016/j.amjsurg.2020.10.031. Epub 2020 Oct 27.

Authors

Dominik A Jakob¹, Elizabeth R Benjamin², Camilla Cremonini³, Demetrios Demetriades⁴

Affiliations

¹ Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County University of Southern California Medical Center, University of Southern California Los Angeles, CA, 90033, USA. Electronic address: Dominik.a.jakob@gmail.com.
² Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County University of Southern California Medical Center, University of Southern California Los Angeles, CA, 90033, USA. Electronic address: Erbenjamin1@gmail.com.
³ Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County University of Southern California Medical Center, University of Southern California Los Angeles, CA, 90033, USA. Electronic address: C.cremonini89@gmail.com.
⁴ Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County University of Southern California Medical Center, University of Southern California Los Angeles, CA, 90033, USA. Electronic address: Demetrios.Demetriades@med.usc.edu.

PMID: 33131692
DOI: 10.1016/j.amjsurg.2020.10.031

Abstract

Background: The aim of this study was to evaluate the management strategies and outcomes of isolated severe pelvic fractures in level I and II ACS verified trauma centers.

Methods: ACS-TQIP database study, including patients with blunt, isolated severe pelvic facture (AIS 3-5).

Results: 2629 level I and 1277 level II patients were included. Early blood product transfusion was significantly higher, pharmacological VTE prophylaxis significantly lower and ICU length of stay significantly longer in level II centers (p < 0.001). On multivariate analysis, treatment at level II centers was independently associated with increased overall complications, specifically ARDS, but not mortality.

Conclusions: In isolated severe pelvic fractures there was a significantly higher use of early blood products, less VTE pharmacological prophylaxis, longer ICU length of stay and higher overall complications and ARDS in level II centers. Blood product utilization and pharmacological VTE prophylaxis are potential areas of quality improvement in level II centers.

Keywords: Angiography; Facility level; Outcome; Pelvic fracture.

MeSH terms

Adult
Aged
Anticoagulants / therapeutic use
Blood Component Transfusion / statistics & numerical data
Female
Fractures, Bone / complications
Fractures, Bone / diagnosis
Fractures, Bone / therapy*
Humans
Injury Severity Score
Intensive Care Units / statistics & numerical data
Length of Stay / statistics & numerical data
Male
Middle Aged
Pelvic Bones / injuries*
Pelvic Bones / surgery
Practice Patterns, Physicians' / organization & administration
Practice Patterns, Physicians' / statistics & numerical data*
Quality Improvement
Respiratory Distress Syndrome / epidemiology
Respiratory Distress Syndrome / etiology
Retrospective Studies
Trauma Centers / organization & administration
Trauma Centers / statistics & numerical data*
Venous Thromboembolism / epidemiology
Venous Thromboembolism / etiology
Venous Thromboembolism / prevention & control
Wounds, Nonpenetrating / complications
Wounds, Nonpenetrating / therapy*

Substances

Anticoagulants