Blunt trauma pelvic fracture-associated genitourinary and concomitant lower gastrointestinal injury: incidence, morbidity, and mortality View Full Text


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Article Info

DATE

2019-03-30

AUTHORS

Nermarie Velazquez, Richard Jacob Fantus, Richard Joseph Fantus, Samuel Kingsley, Marc A. Bjurlin

ABSTRACT

PURPOSE: Limited data exist on the characteristics, risk factors, and management of blunt trauma pelvic fractures causing genitourinary (GU) and lower gastrointestinal (GI) injury. We sought to determine these parameters and elucidate independent risk factors. METHODS: The National Trauma Data Bank for years 2010-2014 was queried for pelvic fractures by ICD-9-CM codes. Exclusion criteria included age ≤ 17 years, penetrating injury, or incomplete records. Patients were divided into three cohorts: pelvic fracture, pelvic fracture with GU injury, and pelvic fracture with GU and GI injury. Between-group comparisons were made using stratified analysis. Multivariable logistic regression was used to determine independent risk factors for concomitant GI injury. RESULTS: In total, 180,931 pelvic fractures were found, 3.3% had GU, and 0.15% had GU and GI injury. Most common mechanism was vehicular collision. Injury severity score, pelvic AIS, and mortality were higher with combined injury (p < 0.001), leading to longer hospital and ICU stays and ventilator days (p < 0.001) with more frequent discharges to acute rehabilitation (p < 0.01). Surgical management of concomitant injuries involved both urinary (62%) and rectal repairs (81%) or diversions (29% and 46%, respectively). Male gender (OR = 2.42), disruption of the pelvic circle (OR = 6.04), pubis fracture (OR = 2.07), innominate fracture (OR = 1.84), and SBP < 90 mmgh (OR = 1.59) were the strongest independent predictors of combined injury (p < 0.01). CONCLUSION: Pelvic fractures with lower GU and GI injury represent < 1% of pelvic fractures. They are associated with more severe injuries and increased hospital resource utilization. Strongest independent predictors are disruption of the pelvic circle, male gender, innominate fracture, and SBP < 90mm Hg. More... »

PAGES

1-8

References to SciGraph publications

  • 2016-03. Direct and indirect costs of surgically treated pelvic fractures in ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
  • 2000-01. Operative Management of Civilian Rectal Gunshot Wounds: Simpler Is Better in WORLD JOURNAL OF SURGERY
  • 2001-12. Pelvic Fracture and Associated Urologic Injuries in WORLD JOURNAL OF SURGERY
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    http://scigraph.springernature.com/pub.10.1007/s00345-019-02725-7

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    http://dx.doi.org/10.1007/s00345-019-02725-7

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1113143878

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30929048


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