Comparative analysis between identified injuries of victims of fall from height and other mechanisms of closed trauma

Parreira, José Gustavo; Kanamori, Lucas R.; Valinoto, Guilherme C. J.; Perlingeiro, Jacqueline A. Giannini; Soldá, Silvia Cristine; Assef, José Cesar

doi:10.1590/0100-699120140040011

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Original Article • Rev. Col. Bras. Cir. 41 (4) • Jul-Aug 2014 • https://doi.org/10.1590/0100-699120140040011 copy

Comparative analysis between identified injuries of victims of fall from height and other mechanisms of closed trauma

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

to identify predictors of death in blunt trauma patients sustaining pelvic fractures and, posteriorly, compare them to a previously reported series from the same center.

METHOD:

Retrospective analysis of trauma registry data, including blunt trauma patients older than 14 y.o. sustaining pelvic fractures admitted from 2008 to 2010. Patients were assigned into group 1 (dead) or 2 (survivors). We used Student's t, qui square and Fisher's tests for statistical analysis, considering p<0.05 as significant. Posteriorly, we compared predictors of death between both periods.

RESULTS:

Seventy-nine cases were included. Mean RTS, ISS and TRISS were, respectively, 6.44 + 2.22, 28.0 + 15.2 e 0.74 + 0.33. Nineteen patients died (24,0%). Main cause of death was hemorrhage (42,1%). Group 1 was characterized by (p<0.05) lower systolic blood pressure and Glasgow coma scale means on admission, higher heart rate, head AIS, extremity AIS and ISS means, as well as, higher frequency of severe head injuries and complex pelvic fractures. Comparing both periods, we notice that the anatomic and physiologic severity of injury increased (RTS and ISS means). Furthermore, there was a decrease in the impact of associated thoracic and abdominal injuries on the prognosis and an association of lethality with the presence of complex pelvic fractures.

CONCLUSION:

There were significant changes in the predictors of death between these two periods. The impact of thoracic and abdominal associated injures decreased while the importance of severe retroperitoneal hemorrhage increased. There was also an increase in trauma severity, which accounted for high lethality.

Hip fractures; Fractures, closed; Pelvic bones; Prognosis; Trauma severity índices

Variable	Group			1	Group			2	p
	(Deaths)			n=18	(Survivors)			n=61

Age	46.2	+	25.6 anos		39.4	+	16.2 anos		0.316
Systolic blood pressure at admission	66.3	+	54.6 mmHg		124.0	+	33.7 mmHg		<0.001
Heart rate at admission	109.9	+	26.3 bpm		94.2	+	18.2 bpm		0.024
Respiratory rate at admission	16.3	+	12.3 ipm		18.9	+		8.6 ipm	0.420
Glasgow coma scale	9.6	+		4.8	13.2	+		3.6	0.006
Revised trauma score	4.70	+	2.85		7.01	+	1.64		0.004
AIS head	2.9	+		2.1	0.9	+		1.4	0.001
AIS thorax	1.3	+		1.6	1.0	+		1.5	0.497
AIS abdomen	1.2	+		1.6	1.4	+		1.8	0.556
AIS extremities / bone pelvis	4.6	+		0.7	3.2	+		1.3	<0.001
Injury Severity Score	40.9	+	11.4		23.7	+	13.9		<0.001
TRISS	0.43	+	0.36		0.84	+	0.25		<0.001
Volume crystalloids at admission	4428.5	+2234.8 ml			2425.0	+1398.0 ml			0.003
Volume packed red blood cells at admission	552.6	+	665.3 ml		70.0	+	249.2 ml		0.006

Variable	Group	1	Group	2	p
	(Deaths)	n=18	(Survivors)	n=61

Severe injuries in head segment	68.4%		20.0%		<0.001
Severe lesions in the thoracic segment	31.6%		30.0%		0.896
Severe lesions in the abdominal segment	35.0%		31.6%		0.784
Severe injuries in extremities	100.0%		86.7%		0.098
KCK type III fractures	61.1%		15.3%		0.004
Tile C fractures	50.0%		7.3%		<0.001
Male gender	63.2%		71.7%		0.482
Associated comorbidities	31.6%		1.7%		<0.001
Orotracheal intubation at admission	73.7%		21.7%		<0.001
Thorax drainage at admission	15.8%		13.3%		0.788
Vain dissection at admission	42.1%		5.0%		<0.001
Pelvic fixation in OR	42.1%		16.7%		0.021
Angiography and embolization	21.1%		5.1%		0.056
Laparotomy	42.1%		18.3%		0.039
Non-therapeutic laparotomy	36.8%		5.0%		<0.001
Open fracture of upper limb	21.1%		6.7%		0.070
Open fracture of lower limb	21.1%		6.7%		0.070

Type of fracture	Total number	Total deaths	Mortality

KCK I	35	5	14.7%
KCK II	18	2	11.1%
KCK III	20	11	55.0%
Tile A	45	6	13.3%
Tile B	15	3	20.0%
Tile C	13	9	69.2%

Variable	1993 – 1997			2008 – 2009			p
		n = 1 0 3			n = 7 9

Mean age	34.0	+	18 anos	41.0	+ 18.9 anos		0.012
RTS	7.1	+	1.3	6.4	+	2.2	0.008
AIS head segment	1.05	+	1.6	1.4	+	1.8	0.168
AIS thoracic segment	0.65	+	1.2	1.1	+	1.6	0.031
AIS abdominal segment	1.2	+	1.6	1.4	+	1.7	0.417
AIS extremities	2.9	+	1.1	3.6	+	1.3	<0.001
ISS	20.0	+	13.0	28.0	+ 15.2		<0.001
TRISS	0.89	+	0.2	0.74	+ 0.33		<0.001
Fractures KCK III	32.0%			27.4%			0.258
Mortality	19.0%			24.7%			0.567

Variable	1993 - 1997	2008 - 2009

Age	p=0.02	n.s.
AIS > 3 head	p=0.002	<0.001
AIS > 3 thorax	p=0.006	n.s
AIS > 3 abdomen	p=0.005	n.s
Complex pelvic fracture (KCK III)	n.s.	P=0.004

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[1] Mailing address: José Gustavo Parreira E-mail: jgparreira@uol.com.br