Transfery i ścieżki postępowania klinicznego w niestabilnych złamaniach miednicy w ostatnich 10 latach – analiza retrospektywna rejestru urazowego DGU

PURPOSE: Pelvic fractures are classified as stable or unstable. They correlate with a severity of trauma and the initial medical treatment is decisive. This study evaluated the transferrals of such fractures and described the initial treatment as well as the clinical course. METHODS: We analysed retrospective data from a large cohort of the TraumaRegister DGU® (TR-DGU), covering the period from 2014 to 2023, comprising a total of n = 397,910 patients. All patients aged ≥ 16 years were included. Injury patterns were described according to the Abbreviated Injury Scale (AIS), the mechanically unstable fractures were classified with an AIS ≥ 3. We considered all participating hospitals within Germany. The patients were subdivided in three groups: Group 1 = primary admitted patients with outcome, group 2 = pre-treated patients transferred in from other hospitals, and group 3 = primary admitted and early (< 48 h) transferred out. RESULTS: The majority of the patients was male and about 53 years old. Blunt trauma was the leading trauma mechanism. Concomitant injuries (AIS 2+) affected thorax (56%), spinal cord (41%), lower extremities (38%), head (31%) and abdomen (24%). Among primary admitted cases with pelvic fractures (n = 36,398), 21,091 cases (57.9%) had an unstable pelvic fracture (AIS pelvis 3-5). Level 1 trauma centers not only treated 12,836 primary admitted cases with unstable pelvic fractures (83.5%) but also received 2,365 patients (15.4%) from other hospitals via transfer; while only 1% of cases were transferred out early (n = 170). Transfusion was administered in 5,984 patients (16.5%) (AIS 2-5). A pelvic binder was applied in 7,096 (36.3%) patients and surgical stabilisation was performed in 4,075 (14.9%) patients. The length of stay on intensive care unit was highest in AIS 5 with 6 days. The mortality rate was 38.5% in AIS 5, and 9.9% in AIS 2. CONCLUSION: Over the course of the last 10 years, the prevalence of unstable pelvic ring fractures (AIS 3-5) constantly remained around 9%. Unstable pelvic fractures were increasingly transferred to a Level I trauma center. Unstable pelvic fractures correlated with a high Injury Severity Score (ISS). The early treatment involved the transfusion of packed red blood cells, the application of a pelvic binder and the surgical stabilisation. Though, these tools were increasingly utilized with the severity of trauma.