Improvement of outcomes in patients with pelvic fractures and hemodynamic instability after the establishment of a Korean regional trauma center

Ji Young Jang, Hongjin Shim, Hye Youn Kwon, Hoejeong Chung, Pil Young Jung, Seongyup Kim, Hoon Ryu, Keum Seok Bae

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Abstract

Purpose: Despite using a multidisciplinary treatment approach, the mortality rate of patients with hemodynamic instability from severe pelvic fractures is still 40–60%. We evaluated the improvement of outcomes in this patient population after the establishment of a regional trauma center in Korea. Methods: We retrospectively reviewed the medical charts of 50 patients with hemodynamic instability due to pelvic fractures between March 2011 and November 2016. Patients were divided into two groups: the pre-trauma center (PTC) group (n = 23) and trauma center (TC) group (n = 27). Results: Sixteen (32.0%) patients died of exsanguination. Patients in the TC group had shorter trauma resuscitation room stay (101 vs 273 min, p < 0.001) and underwent preperitoneal pelvic packing (PPP) more frequently (88.9 vs 8.7%, p < 0.001) than those in the PTC group. During the TC period, emergent procedures such as PPP and pelvic angiography were performed more frequently (92.6 vs 39.1%, p < 0.001). Although there was no statistical difference in the overall mortality rate between groups, patients in the TC group had less mortality due to hemorrhage (18.5 vs 47.8%, p = 0.027). Logistic regression analysis demonstrated that initial systolic blood pressure and establishment of trauma center were independent protective factors of mortality from hemorrhage [odds ratio (OR) 0.957, 95% confidence interval (CI) 0.926–0.988, p = 0.007; OR 0.134, 95% CI 0.028–0.633, p = 0.011]. Conclusions: Since the regional trauma center was established, emergent procedures such as pelvic angiography and PPP were performed more frequently, and mortality due to exsanguination was significantly decreased.

Original languageEnglish
Pages (from-to)107-113
Number of pages7
JournalEuropean Journal of Trauma and Emergency Surgery
Volume45
Issue number1
DOIs
Publication statusPublished - 2019 Feb 5

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Trauma Centers
Hemodynamics
Mortality
Exsanguination
Angiography
Odds Ratio
Confidence Intervals
Hemorrhage
Blood Pressure
Stress Fractures
Korea
Resuscitation
Logistic Models
Regression Analysis
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Surgery
  • Emergency Medicine
  • Orthopedics and Sports Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Jang, Ji Young ; Shim, Hongjin ; Kwon, Hye Youn ; Chung, Hoejeong ; Jung, Pil Young ; Kim, Seongyup ; Ryu, Hoon ; Bae, Keum Seok. / Improvement of outcomes in patients with pelvic fractures and hemodynamic instability after the establishment of a Korean regional trauma center. In: European Journal of Trauma and Emergency Surgery. 2019 ; Vol. 45, No. 1. pp. 107-113.
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title = "Improvement of outcomes in patients with pelvic fractures and hemodynamic instability after the establishment of a Korean regional trauma center",
abstract = "Purpose: Despite using a multidisciplinary treatment approach, the mortality rate of patients with hemodynamic instability from severe pelvic fractures is still 40–60{\%}. We evaluated the improvement of outcomes in this patient population after the establishment of a regional trauma center in Korea. Methods: We retrospectively reviewed the medical charts of 50 patients with hemodynamic instability due to pelvic fractures between March 2011 and November 2016. Patients were divided into two groups: the pre-trauma center (PTC) group (n = 23) and trauma center (TC) group (n = 27). Results: Sixteen (32.0{\%}) patients died of exsanguination. Patients in the TC group had shorter trauma resuscitation room stay (101 vs 273 min, p < 0.001) and underwent preperitoneal pelvic packing (PPP) more frequently (88.9 vs 8.7{\%}, p < 0.001) than those in the PTC group. During the TC period, emergent procedures such as PPP and pelvic angiography were performed more frequently (92.6 vs 39.1{\%}, p < 0.001). Although there was no statistical difference in the overall mortality rate between groups, patients in the TC group had less mortality due to hemorrhage (18.5 vs 47.8{\%}, p = 0.027). Logistic regression analysis demonstrated that initial systolic blood pressure and establishment of trauma center were independent protective factors of mortality from hemorrhage [odds ratio (OR) 0.957, 95{\%} confidence interval (CI) 0.926–0.988, p = 0.007; OR 0.134, 95{\%} CI 0.028–0.633, p = 0.011]. Conclusions: Since the regional trauma center was established, emergent procedures such as pelvic angiography and PPP were performed more frequently, and mortality due to exsanguination was significantly decreased.",
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Improvement of outcomes in patients with pelvic fractures and hemodynamic instability after the establishment of a Korean regional trauma center. / Jang, Ji Young; Shim, Hongjin; Kwon, Hye Youn; Chung, Hoejeong; Jung, Pil Young; Kim, Seongyup; Ryu, Hoon; Bae, Keum Seok.

In: European Journal of Trauma and Emergency Surgery, Vol. 45, No. 1, 05.02.2019, p. 107-113.

Research output: Contribution to journalArticle

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T1 - Improvement of outcomes in patients with pelvic fractures and hemodynamic instability after the establishment of a Korean regional trauma center

AU - Jang, Ji Young

AU - Shim, Hongjin

AU - Kwon, Hye Youn

AU - Chung, Hoejeong

AU - Jung, Pil Young

AU - Kim, Seongyup

AU - Ryu, Hoon

AU - Bae, Keum Seok

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N2 - Purpose: Despite using a multidisciplinary treatment approach, the mortality rate of patients with hemodynamic instability from severe pelvic fractures is still 40–60%. We evaluated the improvement of outcomes in this patient population after the establishment of a regional trauma center in Korea. Methods: We retrospectively reviewed the medical charts of 50 patients with hemodynamic instability due to pelvic fractures between March 2011 and November 2016. Patients were divided into two groups: the pre-trauma center (PTC) group (n = 23) and trauma center (TC) group (n = 27). Results: Sixteen (32.0%) patients died of exsanguination. Patients in the TC group had shorter trauma resuscitation room stay (101 vs 273 min, p < 0.001) and underwent preperitoneal pelvic packing (PPP) more frequently (88.9 vs 8.7%, p < 0.001) than those in the PTC group. During the TC period, emergent procedures such as PPP and pelvic angiography were performed more frequently (92.6 vs 39.1%, p < 0.001). Although there was no statistical difference in the overall mortality rate between groups, patients in the TC group had less mortality due to hemorrhage (18.5 vs 47.8%, p = 0.027). Logistic regression analysis demonstrated that initial systolic blood pressure and establishment of trauma center were independent protective factors of mortality from hemorrhage [odds ratio (OR) 0.957, 95% confidence interval (CI) 0.926–0.988, p = 0.007; OR 0.134, 95% CI 0.028–0.633, p = 0.011]. Conclusions: Since the regional trauma center was established, emergent procedures such as pelvic angiography and PPP were performed more frequently, and mortality due to exsanguination was significantly decreased.

AB - Purpose: Despite using a multidisciplinary treatment approach, the mortality rate of patients with hemodynamic instability from severe pelvic fractures is still 40–60%. We evaluated the improvement of outcomes in this patient population after the establishment of a regional trauma center in Korea. Methods: We retrospectively reviewed the medical charts of 50 patients with hemodynamic instability due to pelvic fractures between March 2011 and November 2016. Patients were divided into two groups: the pre-trauma center (PTC) group (n = 23) and trauma center (TC) group (n = 27). Results: Sixteen (32.0%) patients died of exsanguination. Patients in the TC group had shorter trauma resuscitation room stay (101 vs 273 min, p < 0.001) and underwent preperitoneal pelvic packing (PPP) more frequently (88.9 vs 8.7%, p < 0.001) than those in the PTC group. During the TC period, emergent procedures such as PPP and pelvic angiography were performed more frequently (92.6 vs 39.1%, p < 0.001). Although there was no statistical difference in the overall mortality rate between groups, patients in the TC group had less mortality due to hemorrhage (18.5 vs 47.8%, p = 0.027). Logistic regression analysis demonstrated that initial systolic blood pressure and establishment of trauma center were independent protective factors of mortality from hemorrhage [odds ratio (OR) 0.957, 95% confidence interval (CI) 0.926–0.988, p = 0.007; OR 0.134, 95% CI 0.028–0.633, p = 0.011]. Conclusions: Since the regional trauma center was established, emergent procedures such as pelvic angiography and PPP were performed more frequently, and mortality due to exsanguination was significantly decreased.

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