Transferrals and clinical pathways of unstable pelvic fractures over the last 10 years - A retrospective analysis of the Trauma Register 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 hours) 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 fracture (83.5%) but also received 2,365 patients (15.4%) from other hospitals via transfer; only 1% of cases were transferred out early (n = 170). Transfusion was applied 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 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. The unstable pelvic fractures correlated with a high the 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.