K. C. Brinton1,2, M. E. Tharp1,2, P. K. Gallagher1,2, J. F. Xie1,2, J. Wycech Knight1,3, I. Puente1,2,3, A. A. Fokin1,2 1Delray Medical Center, Trauma And Critical Care Services, DELRAY BEACH, FL, USA 2Florida Atlantic University, Charles E Schmidt College Of Medicine, Boca Raton, FL, USA 3Broward Health Medical Center, Trauma And Critical Care Services, Fort Lauderdale, FL, USA
Introduction: Due to anatomical proximity, concomitant abdominal injuries in patients with pelvic fractures are common. The aim was to compare clinical characteristics, management, and outcomes of patients with pelvic fractures and abdominal co-injuries versus without.
Methods: This retrospective cohort study included 558 adult (≥18 years old) patients with pelvic fractures admitted to a level 1 trauma center between 01/2017 – 01/2023. Two groups were analyzed: 93 patients with abdominal co-injuries and 465 without abdominal co-injuries. To ensure pelvic trauma comparability, patients were propensity score matched by Abbreviated Injury Scale (AIS) pelvis/lower limbs, mechanism of injury (MOI), and age, which resulted in 83 pairs for comparison. Analyzed variables included: injury severity score (ISS), computed tomography (CT), rates of pelvic angiography and embolization, pelvic surgery, exploratory laparotomy, hospital length of stay (HLOS), and mortality.
Results: Overall, abdominal co-injuries were present in 16% of patients with pelvic fractures. Patients with abdominal injuries were younger (56.0 vs 63.3, p=0.003) and in both groups the most common MOI was motor vehicle accident (81.7% vs 57.6%, p<0.001). The abdominal injuries included: solid organs (liver, kidney, spleen) in 36.6%, vessels only (mesentery/Iliac/thoracic aorta) in 15.1%, hollow viscus (bladder, bowel) in 14.0%, hollow viscus + vessels in 10.8%, solid organs + vessels in 9.7%, solid organs + hollow viscus in 6.5%, and solid organs + diaphragm in 6.5%. After propensity matching in abdominal and no abdominal co-injury groups, the mean age was 56, motor vehicle MOI was in 82%, and mean AIS pelvis was 2.9. Matched patients with abdominal co-injuries had higher ISS (25.6 vs 17.5), more blush on contrast CT (40.0% vs 15.3%) and more often received angiography (47.0% vs 19.3%), all p<0.001, however there was no significant difference in embolization rates (64.1% vs 68.8%, p=0.7). Abdominal co-injury patients more often required pelvic packing (27.7% vs 6.0%, p<0.001) and exploratory laparotomy (54.2% vs 4.8%, p<0.001), but both groups had identical rates of orthopedic pelvic surgery (22.9%). Patients with abdominal co-injuries had longer HLOS (22.0 vs 11.0 days, p<0.001) and higher mortality (18.3% vs 4.9%, p<0.001).
Conclusion: Concomitant abdominal injuries occurred in 16% of patients with pelvic fractures. One third of these patients had damage to a solid organ, the most common of which was the liver. Patients with pelvic fracture and abdominal co-injuries had pelvic packing more often, longer hospital stay and higher mortality, however rates of embolization and orthopedic pelvic surgeries were similar to patients without abdominal co-injuries.
