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Higher mortality rates after pelvic injury found at non-trauma centers
Care at level one trauma centers improved function for patients with pelvic ring and acetabular injuries.
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 Saam Morshed |
SAN ANTONIO — Patients with severe acetabular injuries treated at level one trauma centers showed improved physical function and significantly lower mortality risks than those treated at non-trauma centers, according to a study presented at the 2011 Annual Meeting of the Orthopaedic Trauma Association.
“Patients with combined pelvic and acetabular injuries experienced decreased mortality at level one trauma centers vs. non-trauma centers,” study investigator Saam Morshed, MD, said during his presentation. “Patients with B and C-type injuries experienced decreased mortality and 1-year function improvement at trauma vs. non-trauma centers.”
Morshed and colleagues pulled data from 18 trauma centers and 51 non-trauma centers from 14 states. The study included 829 adult patients with preoperative Abbreviated Injury Scale scores of 3 or greater. The group included 553 pelvic ring injuries, 62 acetabular injuries, and 177 combined acetabular and pelvic ring injuries.
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AP views are shown preoperatively (left) and postoperatively (right) of a patient with combined pelvic ring and acetabular fractures. Images: Morshed S |
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After adjusting for case mix, Morshed said, the 1-year results showed a “clear trend toward decreasing mortality in patients treated at trauma centers.” Patients with combined acetabular and pelvic injuries treated at trauma centers showed lower mortality at 90 days and 1 year compared to those treated at non-trauma centers. SF-36 and Musculoskeletal Function Assessment scores showed improved functional outcomes in patients with severe acetabular injuries treated at trauma centers compared to those treated at the other centers.
Morshed noted that the researchers did not consider the effectiveness of intermediate trauma care. They “only included non-trauma centers with at least 25 major trauma patients per year,” which is “higher than the national average for non-trauma centers.” They also only collected and adjusted for data with known covariates.
“We believe that this conservatively biases our estimate for trauma center effect,” Morshed said. – by Renee Blisard
References:
- Morshed S, Jurkovich GJ, Wang J, Knops S, Rivara FP. The importance of trauma center care on mortality and function following pelvic ring and acetabular injuries. Paper #46. Presented at the 2011 Annual Meeting of the Orthopaedic Trauma Association. Oct. 12-15. San Antonio.
- Saam Morshed, MD, can be reached at San Francisco General Hospital, 2550 23rd St., Bldg. 9, 2nd Flr., San Francisco, CA 94110; 415-206-8812; email: morsheds@orthosurg.ucsf.edu.
- Disclosure: Morshed has no relevant financial disclosures.