The Journal of Bone and Joint Surgery (American). 2009;91:2803-2810.
doi:10.2106/JBJS.H.00598
© 2009 The Journal of Bone and Joint Surgery, Inc.
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The Effect of Pelvic Fracture on Mortality After Trauma: An Analysis of 63,000 Trauma Patients

Ashoke K. Sathy, MD1, Adam J. Starr, MD2, Wade R. Smith, MD3, Alan Elliott, MS2, Juan Agudelo, MD3, Charles M. Reinert, MD2 and Joseph P. Minei, MD2

1 Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883
2 Departments of Orthopaedic Surgery (A.J.S. and C.M.R.), Biostatistics (A.E.), and General Surgery (J.P.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390. E-mail address for A.J. Starr: Adam.starr{at}utsouthwestern.edu
3 Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, MC 0188, Denver, CO 80204

Investigation performed at the University of Texas Southwestern Medical Center, Dallas, Texas, and Denver Health Medical Center, Denver, Colorado

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the Suzanne and Aaron A. Hoffman, MD, Orthopaedic Research Fund. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

A commentary by Steven A. Olson, MD, is available at www.jbjs.org/commentary and as supplemental material to the online version of this article.

Background: The understanding of the mortality risk posed by pelvic fracture is incomplete. The purposes of this study were (1) to compare the mortality risk associated with a pelvic fracture with the risk conferred by other injuries and (2) to determine if the association of a pelvic fracture with mortality varies when combined with other known risk factors.

Methods: Trauma registry records from two level-I trauma centers were examined. Regression analysis was done on 63,033 patients to assess the odds ratio for mortality associated with pelvic fracture compared with other variables such as age, shock, head injury, abdominal or chest injury, and extremity injury. A second analysis was carried out to determine if the impact of a pelvic fracture on mortality varied when combined with other known risk factors for mortality.

Results: Logistic regression analysis demonstrated that pelvic fracture was significantly associated with mortality (p < 0.001). The odds ratio for mortality associated with a pelvic fracture (approximately 2) was similar to that posed by an abdominal injury. Hemodynamic shock, severe head injury, and an age of sixty years or more all had an odds ratio for mortality greater than that associated with pelvic fracture.

Conclusions: For the majority of trauma patients, pelvic fracture is significantly associated with a greater risk of mortality. However, pelvic fracture is one variable among many that contribute to mortality risk, and it must be considered in relation to these other variables.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.


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