Published online Aug 18, 2016. doi: 10.5312/wjo.v7.i8.481
Peer-review started: February 19, 2016
First decision: March 25, 2016
Revised: April 8, 2016
Accepted: June 1, 2016
Article in press: June 3, 2016
Published online: August 18, 2016
AIM: To determine the association of unstable pelvic ring injuries with trauma code status.
METHODS: A retrospective review of all pelvic ring injuries at a single academic center from July 2010 to June 2013 was performed. The trauma registry was used to identify level 1 and level 2 trauma codes for each injury. The computed tomography scans in all patients were classified as stable or unstable using the Abbreviated Injury Scale. Pelvic injury classifications in level 1 and level 2 groups were compared. Patient disposition at discharge in level 1 and level 2 groups were also compared.
RESULTS: There were 108 level 1 and 130 level 2 blunt trauma admissions. In the level 1 group, 67% of pelvic injuries were classified as stable fracture patterns and 33% were classified as unstable. In the level 2 group, 62% of pelvic injuries were classified as stable fracture patterns and 38% were classified as unstable. level 1 trauma code was not associated with odds of having an unstable fracture pattern (OR = 0.83, 95%CI: 0.48-1.41, P = 0.485). In the level 1 group with unstable pelvic injuries, 33% were discharged to home, 36% to a rehabilitation facility, and 32% died. In the level 2 group with unstable pelvic injuries, 65% were discharged to home, 31% to a rehabilitation facility, and 4% died. For those with unstable pelvic fractures (n = 85), assignment of a level 2 trauma code was associated with reduced odds of death (OR = 0.07, 95%CI: 0.01-0.35, P = 0.001) as compared to being discharged to home.
CONCLUSION: Trauma code level assignment is not correlated with severity of pelvic injury. Because an unstable pelvis can lead to hemodynamic instability, these injuries may be undertriaged.
Core tip: The assignment of trauma level is important as it dictates the urgency of response and the size of the responding team. Because of the high morbidity and mortality from pelvic fractures, especially unstable pelvic fractures, it is critical that these injuries be appropriately triaged once discovered or suspected. Our study did not show an association between the severity of the pelvic ring injury and the trauma code level. This lack of an association suggests patients with significant pelvic injuries may be under-triaged. These injuries may benefit from a more severe trauma code status to prevent any undue morbidity or mortality.