Pelvic trauma mortality reduced by integrated trauma care

Mark Fitzgerald, Max Esser, Matthias Russ, Joseph Mathew, Dinesh Varma, Andrew Wilkinson, Rejith V. Mannambeth, Devilliers Smit, Stephen Bernard, Biswadev Mitra

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives: A multidisciplinary approach that emphasised improved triage, early pelvic binder application, early administration of blood and blood products, adherence to algorithmic pathways, screening with focused sonography (FAST), early computed tomography scanning with contrast angiography, angio-embolisation and early operative intervention by specialist pelvic surgeons was implemented in the last decade to improve outcomes after pelvic trauma. The manuscript evaluated the effect of this multi-faceted change over a 12-year period. Methods: A retrospective cohort study was conducted comparing patients presenting with serious pelvic injury in 2002 to those presenting in 2013. The primary exposure and comparator variables were the year of presentation and the primary outcome variable was mortality at hospital discharge. Potential confounders were evaluated using multivariable logistic regression analysis. Results: There were 1213 patients with a serious pelvic injury (Abbreviated Injury Scale≥3), increasing from 51 in 2002 to 156 in 2013. Demographics, injury severity and presenting clinical characteristics were similar between the two time periods. There was a statistically significant difference in mortality from 20% in 2002 to 7.7% in 2013 (P=0.02). The association between the primary exposure variable of being injured in 2013 and mortality remained statistically significant (adjusted odds ratio 0.10; 95% confidence interval: 0.02-0.60) when adjusted for potential clinically important confounders. Conclusions: Multi-faceted interventions directed at the spectrum of trauma resuscitation from pre-hospital care to definitive surgical management were associated with significant reduction in mortality of patients with severe pelvic injury from 2002 to 2013. This demonstrates the effectiveness of an integrated, inclusive trauma system in achieving improved outcomes.

Original languageEnglish
Pages (from-to)444-449
Number of pages6
JournalEMA - Emergency Medicine Australasia
Volume29
Issue number4
DOIs
Publication statusPublished - Aug 2017

Keywords

  • Error reduction
  • Pelvic fractures
  • Resuscitation
  • Trauma

Cite this

@article{07ee97ca3e434c5d80d92049017b49dd,
title = "Pelvic trauma mortality reduced by integrated trauma care",
abstract = "Objectives: A multidisciplinary approach that emphasised improved triage, early pelvic binder application, early administration of blood and blood products, adherence to algorithmic pathways, screening with focused sonography (FAST), early computed tomography scanning with contrast angiography, angio-embolisation and early operative intervention by specialist pelvic surgeons was implemented in the last decade to improve outcomes after pelvic trauma. The manuscript evaluated the effect of this multi-faceted change over a 12-year period. Methods: A retrospective cohort study was conducted comparing patients presenting with serious pelvic injury in 2002 to those presenting in 2013. The primary exposure and comparator variables were the year of presentation and the primary outcome variable was mortality at hospital discharge. Potential confounders were evaluated using multivariable logistic regression analysis. Results: There were 1213 patients with a serious pelvic injury (Abbreviated Injury Scale≥3), increasing from 51 in 2002 to 156 in 2013. Demographics, injury severity and presenting clinical characteristics were similar between the two time periods. There was a statistically significant difference in mortality from 20{\%} in 2002 to 7.7{\%} in 2013 (P=0.02). The association between the primary exposure variable of being injured in 2013 and mortality remained statistically significant (adjusted odds ratio 0.10; 95{\%} confidence interval: 0.02-0.60) when adjusted for potential clinically important confounders. Conclusions: Multi-faceted interventions directed at the spectrum of trauma resuscitation from pre-hospital care to definitive surgical management were associated with significant reduction in mortality of patients with severe pelvic injury from 2002 to 2013. This demonstrates the effectiveness of an integrated, inclusive trauma system in achieving improved outcomes.",
keywords = "Error reduction, Pelvic fractures, Resuscitation, Trauma",
author = "Mark Fitzgerald and Max Esser and Matthias Russ and Joseph Mathew and Dinesh Varma and Andrew Wilkinson and Mannambeth, {Rejith V.} and Devilliers Smit and Stephen Bernard and Biswadev Mitra",
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Pelvic trauma mortality reduced by integrated trauma care. / Fitzgerald, Mark; Esser, Max; Russ, Matthias; Mathew, Joseph; Varma, Dinesh; Wilkinson, Andrew; Mannambeth, Rejith V.; Smit, Devilliers; Bernard, Stephen; Mitra, Biswadev.

In: EMA - Emergency Medicine Australasia, Vol. 29, No. 4, 08.2017, p. 444-449.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Pelvic trauma mortality reduced by integrated trauma care

AU - Fitzgerald, Mark

AU - Esser, Max

AU - Russ, Matthias

AU - Mathew, Joseph

AU - Varma, Dinesh

AU - Wilkinson, Andrew

AU - Mannambeth, Rejith V.

AU - Smit, Devilliers

AU - Bernard, Stephen

AU - Mitra, Biswadev

PY - 2017/8

Y1 - 2017/8

N2 - Objectives: A multidisciplinary approach that emphasised improved triage, early pelvic binder application, early administration of blood and blood products, adherence to algorithmic pathways, screening with focused sonography (FAST), early computed tomography scanning with contrast angiography, angio-embolisation and early operative intervention by specialist pelvic surgeons was implemented in the last decade to improve outcomes after pelvic trauma. The manuscript evaluated the effect of this multi-faceted change over a 12-year period. Methods: A retrospective cohort study was conducted comparing patients presenting with serious pelvic injury in 2002 to those presenting in 2013. The primary exposure and comparator variables were the year of presentation and the primary outcome variable was mortality at hospital discharge. Potential confounders were evaluated using multivariable logistic regression analysis. Results: There were 1213 patients with a serious pelvic injury (Abbreviated Injury Scale≥3), increasing from 51 in 2002 to 156 in 2013. Demographics, injury severity and presenting clinical characteristics were similar between the two time periods. There was a statistically significant difference in mortality from 20% in 2002 to 7.7% in 2013 (P=0.02). The association between the primary exposure variable of being injured in 2013 and mortality remained statistically significant (adjusted odds ratio 0.10; 95% confidence interval: 0.02-0.60) when adjusted for potential clinically important confounders. Conclusions: Multi-faceted interventions directed at the spectrum of trauma resuscitation from pre-hospital care to definitive surgical management were associated with significant reduction in mortality of patients with severe pelvic injury from 2002 to 2013. This demonstrates the effectiveness of an integrated, inclusive trauma system in achieving improved outcomes.

AB - Objectives: A multidisciplinary approach that emphasised improved triage, early pelvic binder application, early administration of blood and blood products, adherence to algorithmic pathways, screening with focused sonography (FAST), early computed tomography scanning with contrast angiography, angio-embolisation and early operative intervention by specialist pelvic surgeons was implemented in the last decade to improve outcomes after pelvic trauma. The manuscript evaluated the effect of this multi-faceted change over a 12-year period. Methods: A retrospective cohort study was conducted comparing patients presenting with serious pelvic injury in 2002 to those presenting in 2013. The primary exposure and comparator variables were the year of presentation and the primary outcome variable was mortality at hospital discharge. Potential confounders were evaluated using multivariable logistic regression analysis. Results: There were 1213 patients with a serious pelvic injury (Abbreviated Injury Scale≥3), increasing from 51 in 2002 to 156 in 2013. Demographics, injury severity and presenting clinical characteristics were similar between the two time periods. There was a statistically significant difference in mortality from 20% in 2002 to 7.7% in 2013 (P=0.02). The association between the primary exposure variable of being injured in 2013 and mortality remained statistically significant (adjusted odds ratio 0.10; 95% confidence interval: 0.02-0.60) when adjusted for potential clinically important confounders. Conclusions: Multi-faceted interventions directed at the spectrum of trauma resuscitation from pre-hospital care to definitive surgical management were associated with significant reduction in mortality of patients with severe pelvic injury from 2002 to 2013. This demonstrates the effectiveness of an integrated, inclusive trauma system in achieving improved outcomes.

KW - Error reduction

KW - Pelvic fractures

KW - Resuscitation

KW - Trauma

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U2 - 10.1111/1742-6723.12820

DO - 10.1111/1742-6723.12820

M3 - Article

VL - 29

SP - 444

EP - 449

JO - EMA - Emergency Medicine Australasia

JF - EMA - Emergency Medicine Australasia

SN - 1742-6731

IS - 4

ER -