Hemorrhagic Shock in Isolated and Non-Isolated Pelvic Fractures: A Registries-Based Study

Figures & data

Figure 1. Flow diagram of casualties included in the study. Abbreviations: IDF-TR = Israel Defense Forces Trauma Registry; INTR = Israel National Trauma Registry.

Table 1. Baseline and injury characteristics of study population, stratified by presence of isolated vs. non-isolated pelvic fracture.

	Patients with pelvic fractures
	Isolated n = 68	Non-isolated n = 176	Total n = 244	p-value^a
Age - Median (IQR), years	21 (20-26)	20 (19-24)	21 (19-25)	0.222
Male Sex - N (%)	56 (82.4)	150 (85.2)	206 (84.4)	0.561
Presence of penetrating injury - N (%)	12 (17.6)	27 (15.3)	39 (16.0)	0.698
Mechanism of injury - N (%)
Motor vehicle collision	41 (60.3)	117 (66.5)	158 (64.8)	0.631
Fall	12 (17.6)	20 (11.4)	32 (13.1)
Blunt object strike	2 (2.9)	2 (1.1)	4 (1.6)
Shrapnel	0 (0.0)	1 (0.6)	1 (0.4)
Gunshot	9 (13.2)	19 (10.8)	28 (11.5)
Blast	2 (2.9)	7 (4.0)	9 (3.7)
Other	2 (2.9)	10 (5.7)	12 (4.9)
Severely injured body regions (AIS ≥ 3) - N (%)
Head	0 (0.0)	59 (33.5)	59 (24.2)	–
Neck	0 (0.0)	2 (1.1)	2 (0.8)	–
Face	0 (0.0)	8 (4.5)	8 (3.3)	–
Abdomen	0 (0.0)	84 (47.7)	84 (34.4)	–
Thorax	0 (0.0)	98 (55.7)	98 (40.2)	–
Spine	0 (0.0)	14 (8.0)	14 (5.7)	–
External	0 (0.0)	0 (0.0)	0 (0.0)	–
Upper Extremity	0 (0.0)	29 (16.5)	29 (11.9)	–
Lower Extremity (Including pelvic fractures)	33 (48.5)	117 (66.5)	150 (61.5)	–
Lower Extremity other than pelvic fracture^b	0 (0.0)	64 (36.4)	64 (26.2)	–
Injury severity score - N (%)
1-8	31 (45.6)	0 (0.0)	31 (12.7)	<0.001
9-14	35 (51.5)	39 (22.2)	74 (30.3)
16-24	2 (2.9)	38 (21.6)	40 (16.4)
≥25	0 (0.0)	99 (56.3)	99 (40.6)
Pelvic fracture type - N (%)
Closed	57 (83.8)	146 (83.0)	203 (83.2)	1.000
Open	11 (16.2)	31 (17.6)	42 (17.2)	0.852
Pelvic fracture site - N (%)
Acetabulum	25 (36.8)	68 (38.6)	93 (38.1)	0.883
Pubis	30 (44.1)	90 (51.1)	120 (49.2)	0.392
Ilium	9 (13.2)	14 (8.0)	29 (9.4)	0.225
Ischium	0 (0.0)	0 (0.0)	0 (0.0)	–
Sacrum or Coccyx	19 (27.9)	38 (21.6)	57 (23.4)	0.314
Multiple sites	1 (1.5)	17 (9.7)	18 (7.4)	0.028
Other or unspecified	4 (5.9)	9 (5.1)	13 (5.3)	0.759

^ap-values acquired from Chi-squared test, Fisher’s Exact Test or Kruskal-Wallis Test.

^bPelvic fracture AIS is nested under the lower extremity region.

Abbreviations: AIS = Abbreviated Injury Scale; ED = emergency department; IQR = interquartile range.

Table 2. Prehospital and in-hospital interventions administered to the study population.

	Patients with pelvic fractures
	Isolated n = 68	Non-isolated n = 176	Total n = 244	p-value^a
Prehospital life-saving interventions - N (%)
Endotracheal intubation	0 (0.0)	38 (21.6)	38 (15.6)	<0.001
Tourniquet application	1 (1.5)	7 (4.0)	8 (3.3)	0.449
Crystalloids	9 (13.2)	34 (19.3)	43 (17.6)	0.349
Freeze-dried plasma	3 (4.4)	12 (6.8)	15 (6.1)	0.569
Tranexamic acid	5 (7.4)	20 (11.4)	25 (10.2)	0.481
Emergency department interventions - N (%)
Endotracheal intubation	0 (0.0)	45 (25.6)	45 (18.4)	<0.001
Blood products^b	3 (5.1)	38 (24.8)	41 (19.3)	<0.001
In-hospital surgical interventions - N (%)
Any fracture related operation	18 (26.5)	93 (52.8)	111 (45.5)	<0.001
External fixation	2 (2.9)	23 (13.1)	25 (10.2)	0.018
Open reduction and internal fixation	13 (19.1)	59 (33.5)	72 (29.5)	0.029
Closed reduction and internal fixation	1 (1.5)	30 (17.0)	31 (12.7)	<0.001

^ap-values acquired from Chi-squared test or Fisher’s Exact Test.

^b Missing data for 32 patients.

Abbreviations: ED = emergency department; IQR = interquartile range.

Figure 2. Comparison of the vital signs and in-hospital outcomes of patients with isolated and non-isolated pelvic fractures. Boxplots compare the systolic blood pressure (A) and heart rate (B) upon emergency department arrival as well as hospital length of stay (C) between the groups. Panel D compares the proportions of presentation with signs of profound shock upon arrival, intensive care unit (ICU) admission and in-hospital mortality. **P < 0.01, ***P < 0.001, and ****P < 0.0001.