Pubic and Multiple Pelvic Fractures in Trauma Patients Are Associated With Intensive Care Unit Admission

TL;DR

Patients with pubic or multiple pelvic fractures are more likely to need ICU admission after trauma, which can help guide early triage decisions.

Contribution

The study identifies pubic fractures and multiple pelvic fractures as independent predictors of ICU admission in trauma patients.

Findings

Patients with pubic fractures were significantly more likely to be admitted to the ICU.

Pubic fractures were independently predictive of ICU admission compared to other single fractures.

Patients with pubic fractures often had multiple fractures and required more intensive treatments like blood transfusions.

Abstract

Introduction: Pelvic fractures usually result from high-energy trauma, often presenting as polytrauma and frequently requiring intensive care management. Anatomical severity is generally considered to be associated with intensive care unit (ICU) admission in trauma patients. This study investigated the specific types of pelvic fractures that are associated with ICU admission.

Methods: We retrospectively analyzed trauma patients transported to Gunma University Hospital in Maebashi, Japan, between April 1, 2017, and March 31, 2022. Pelvic fracture sites were categorized into 10 regions (left/right ilium, ischium, pubis, sacrum, and acetabulum). The relationship between fracture patterns and ICU admission was then analyzed.

Results: A total of 59 patients were included in the analysis. The Mann-Whitney U test and Fisher's exact test were used to analyze the relationship between the number of fractures, fracture type, and ICU admission. While there were no significant differences regarding unstable pelvic fractures (p = 0.06), patients with multiple fractures and pubic fractures were significantly more likely to be admitted to the ICU. Furthermore, patients with pubic fractures frequently had multiple fractures (p < 0.001), were more likely to show extravasation on imaging (p = 0.003), and require blood transfusion (p < 0.001) and endovascular treatment (p = 0.015) more often. Logistic regression analysis revealed that pubic fracture independently predicted ICU admission compared to other single fractures (odds ratio (OR) 11.9, p = 0.012).

Conclusion: Patients with multiple pelvic fractures and/or pubic fractures are more likely to be admitted to the ICU. These findings may assist in early triage decision for pelvic trauma patients.

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