Predictors of mortality following severe pelvic ring fracture: Results of a population-based study Belinda J. Gabbe a,b, *, Richard de Steiger c , Max Esser d,f , Andrew Bucknill e , Matthias K. Russ d,f , Peter A. Cameron a,b,g a Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia b National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia c Epworth Victor Smorgon Chair of Surgery, University of Melbourne, Australia d Department of Surgery, Monash University, The Alfred Hospital, Melbourne, Australia e Department of Orthopaedic Surgery, Royal Melbourne Hospital, Melbourne, Australia f Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Australia g Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia Introduction Traumatic disruption of the pelvic ring is uncommon but is associated with a high risk of mortality. 1–3 These injuries are predominantly due to high energy blunt trauma such as a fall from height, road or workplace trauma, and severe associated injuries are prevalent. 4–6 Whilst a recent study by Lunsjo et al. found that the increased mortality risk in a sample of 100 trauma patients involving pelvic fracture was due to associated injuries, 7 Sathy et al. found that the presence of any pelvic fracture was significantly associated with increased mortality risk in their study of 63,000 trauma cases. 6 The primary reason for the elevated risk of death following pelvic ring disruption is the potential for fracture-related haemorrhage through direct injury to the adjacent vasculature (venous and arterial) from bony fragments, disruption of vessels by shear forces, and bleeding from the bone surfaces. 2–4,8 In the majority of cases, bleeding is venous in nature. The risk of Injury, Int. J. Care Injured 42 (2011) 985–991 ARTICLE INFO Article history: Accepted 3 June 2011 Keywords: Pelvic fracture Mortality Trauma registry Outcomes Risk factors ABSTRACT Introduction: Traumatic disruption of the pelvic ring is uncommon but is associated with a high risk of mortality. These injuries are predominantly due to high energy blunt trauma such as a fall from height, road or workplace trauma, and severe associated injuries are prevalent, increasing the complexity of managing this patient group. The aim of this population-based study was to investigate predictors of mortality following severe pelvic ring fractures managed in an inclusive, regionalised trauma system. Methods: Cases aged  15 years from 1st July 2001 to 30th June 2008 were extracted from the population-based statewide Victorian State Trauma Registry for analysis. Patient demographic, prehospital and admission characteristics were considered as potential predictors of mortality. Multivariate logistic regression was used to identify predictors of mortality with adjusted odds ratios (AOR) and 95% confidence intervals (CI) calculated. Results: There were 348 cases over the 8-year period. The mortality rate was 19%. Patients aged  65 years were at higher odds of mortality (AOR 7.6, 95% CI: 2.8, 20.4) than patients aged 15–34 years. Patients hypotensive at the scene (AOR 5.5, 95% CI: 2.3, 13.2), and on arrival at the definitive hospital of care (AOR 3.7, 955 CI: 1.7, 8.0), were more likely to die than patients without hypotension. The presence of a severe chest injury was associated with an increased odds of mortality (AOR 2.8, 95% CI: 1.3, 6.1), whilst patients injured in intentional events were also more likely to die than patients involved in unintentional events (AOR 4.9, 95% CI: 1.6, 15.6). There was no association between the hospital of definitive management and mortality after adjustment for other variables, despite differences in the protocols for managing these patients at the major trauma services (Level 1 trauma centres). Conclusions: The findings highlight the importance of effective control of haemodynamic instability for reducing the risk of mortality. As most patients survive these injuries, further research should focus on long term morbidity and the impact of different treatment approaches. ß 2011 Elsevier Ltd. All rights reserved. * Corresponding author at: Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Rd., Melbourne, Victoria 3004, Australia. Tel.: +61 3 9903 0951; fax: +61 3 9903 0556. E-mail address: belinda.gabbe@monash.edu (B.J. Gabbe). Contents lists available at ScienceDirect Injury journal homepage: www.elsevier.com/locate/injury 0020–1383/$ – see front matter ß 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2011.06.003