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Analyses of clinical outcomes after severe pelvic fractures: an international study
  1. Kyoungwon Jung1,2,
  2. Shokei Matsumoto2,3,
  3. Alan Smith3,
  4. Kyungjin Hwang1,
  5. John Cook-Jong Lee1,
  6. Raul Coimbra4
  1. 1 Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
  2. 2 Department of Surgery, University of California San Diego Health Sciences, San Diego, California, USA
  3. 3 Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
  4. 4 Riverside University Health System Medical Center and Loma Linda University School of Medicine, Riverside, California, USA
  1. Correspondence to Dr Raul Coimbra, Riverside University Health System Medical Center and Loma Linda University School of Medicine, Moreno Valley, CA 92555, USA; raulcoimbra62{at}yahoo.com

Abstract

Background This study aimed to compare treatment outcomes between patients with severe pelvic fractures treated at a representative trauma center that was established in Korea since 2015 and matched cases treated in the USA.

Methods Two cohorts were selected from a single institution trauma database in South Korea (Ajou Trauma Data Bank (ATDB)) and the National Trauma Data Bank (NTDB) in the USA. Adult blunt trauma patients with a pelvic Abbreviated Injury Scale >3 were included. Patients were matched based on covariates that affect mortality rate using a 1:1 propensity score matching (PSM) approach. We compared differences in outcomes between the two groups, performed survival analysis for the cohort after PSM and identified factors associated with mortality. Lastly, we analyzed factors related to outcomes in the ATDB dataset comparing a period prior to the implementation of the trauma center according to US standards, an interim period and a postimplementation period.

Results After PSM, a total of 320 patients (160 in each cohort) were identified for comparison. Inhospital mortality was significantly higher in the ATDB cohort using χ2 test, but it was not statistically significant when using Kaplan-Meier survival curves and Cox regression analysis. Moreover, the mortality rate was similar comparing the NTDB cohort to ATDB data reflecting the post-trauma center establishment period. Older age, lower systolic blood pressure (SBP) and Glasgow Coma Scale (GCS) at admission were factors associated with mortality.

Discussion Mortality rate after severe pelvic fractures was significantly associated with older age, lower SBP and GCS scores at admission. Efforts to establish a trauma center in South Korea led to improvement in outcomes, which are comparable to those in US centers.

Level of evidence Level IV.

  • pelvic fracture
  • trauma systems and outcomes
  • Outcome and comparison
  • global surgery

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors KJ, SM, AS, KH and RC contributed to study design, data collection, data analysis and data interpretation. KJ, KH and RC were responsible for article writing. KJ, SM, JC-JL and RC were responsible for the critical revision of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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