Analysis Of Epidemiological Characteristics And Risk Factors Of Hemodynamically Unstable Pelvic Fracture

Objective: To study the epidemiological characteristics and risk factors of death in patients with hemodynamically unstable pelvic fracture.Methods:1.The epidemiological characteristics of 102 patients with hemodynamically unstable pelvic fractures admitted to the emergency intensive care unit(EICU)of the Third Hospital of Hebei Medical University from January 2017 to December 2020 were analyzed retrospectively.2.According to the outcome during hospitalization,the patients were divided into survival group and non-survival group.The demographic data,laboratory indexes and related treatment of the two groups were compared.The univariate analysis and multivariable analysis were conducted to analyse the risk factors.3.Through the receiver operating characteristic analysis(ROC),calculate the area under the ROC curve,evaluate its predictive efficiency for the outcome of patients,and calculate the optimum cut-off value for risk data factors.Results:1.102 patients were included in the study.There were 73 males and 29 females,with a male-to-female ratio of 2.52 to 1.52.Age distribution: 15-84 years old,the average age was 49.01±15.83 years old,the high incidence age group was 40-49 years old(27.5%).Twenty cases deteriorated and died during hospitalization,with a mortality rate of 19.6%.Causes of injury: 62 cases(60.8%)were injured by traffic accidents,29 cases(28.4%)were injured by falling from a height,11 cases(10.8%)were injured by heavy objects.According to the classification of Tile classification,there were 31 cases of type A(30.4%),44 cases of type B(43.1%),and 27 cases of type C(26.5%).The mortality rates were 3.2%,22.7%,33.3%respectively,and there was statistical difference among different types of death rates.The average ISS score of type A,B,C were22.52±6.12,26.27±5.99 and 28.78±8.80 points,there was a statistically significant difference in the average ISS scores of type A,B and C pelvic fractures.7 cases(22.6%)of type A vascular intervention,all complicated with vascular injury,19 cases(43.2%)of type B vascular intervention,13 cases(29.5%)of vascular injury,16 cases(59.3%)of type C vascular intervention,14 cases(51.9%)Vascular injuries,the difference is statistically significant.ISS score of patients ranged from 13 to 50,with an average of 25.79±7.22 points,mainly concentrated in 21 to 30 points(59.8%).The average ISS score was 24.55±6.53 points in survival group and 30.90±7.80 points in non-survival group,there was a statistical difference between the two groups.The average ISS score of the massive blood transfusion within 24 hours group was 28.93±8.865 points,and24.61±6.148 points of the non-massive blood transfusion group.The difference between the two groups was statistically significant.All patients had combined injuries,mainly were craniocerebral injury,chest injury and abdominal organ injury.2.Univariate analysis found the following 13 factors were correlated with mortality: age,Temperature(T),Systolic Blood Pressure(SBP),heavy Blood transfusion within 24 hours,use of vasoactive drug,Injury Severity Score(ISS),Sequential Organ Failure Assessment(SOFA),Acute Physiology and Chronic Health Evaluation Scoring System(APACHEⅡ),Creatinine(Cr),Prothrombin Time(PT),Activated partial thromboplastin time(APTT),International Normalized Ratio(INR)and lactic acid(Lactic acid,Lac).3.Logistic analysis found four risk factors: age,ISS,SOFA,and Cr.4.ROC analysis showed the AUC of age,ISS,SOFA,Cr were 0.655,0.731,0.908,0.799.the best cut-off values were: 48.5 years old,27.5 points,11.5 points and 105.8 umol/L.Conclusions:1.Most of the patients with hemodynamically unstable pelvic fractures were middle-aged men,with a mortality rate as high as 19.6%,mainly causes of injury were traffic accident injuries and high fall injuries.Tile C were most likely to be complicated with vascular injuries.The higher the ISS score,the higher the possibility of massive blood transfusion within 24 hours of admission,and the worse the outcome.patients were all complicated with injuries in other parts of the body.2.Age,ISS,SOFA and Cr are risk factors for death in patients with hemodynamically unstable pelvic fractures,suggesting that the patient’s age,degree of injury,and organ function are related to the patient’s outcome.