Severe trauma with associated pelvic fractures: The impact of regional trauma networks on clinical outcome

Nikolaos K Kanakaris; Omar Bouamra; Fiona Lecky; Peter V Giannoudis

doi:10.1016/j.injury.2023.04.006

Severe trauma with associated pelvic fractures: The impact of regional trauma networks on clinical outcome

Injury. 2023 Apr 13:S0020-1383(23)00348-0. doi: 10.1016/j.injury.2023.04.006. Online ahead of print.

Authors

Nikolaos K Kanakaris¹, Omar Bouamra², Fiona Lecky³, Peter V Giannoudis⁴

Affiliations

¹ LEEDS Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom.
² Trauma Research and Audit Network, University of Manchester, 3rd Floor Mayo Building, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
³ Trauma Research and Audit Network, University of Manchester, 3rd Floor Mayo Building, Salford Royal NHS Foundation Trust, Salford, United Kingdom; Centre for Urgent and Emergency Care REsearch (CURE), Health Services Research Section, School of Health and Related Research, University of Sheffield, United Kingdom.
⁴ LEEDS Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom. Electronic address: pgiannoudi@aol.com.

PMID: 37085351
DOI: 10.1016/j.injury.2023.04.006

Abstract

Lately, the care of severely injured patients in the United Kingdom has undergone a significant transformation. The establishment of regional trauma networks (RTN) with designated Major Trauma Centers (MTCs) and satellite hospitals called Trauma Units (TUs) has centralized the care of severely injured patients in the MTCs. Pelvic fractures are notoriously linked with hypovolemic shock or even death from excessive blood loss. The aim of this prospective cohort study is to compare the profile of severely injured patients with combined pelvic fractures and their mortality between two different distinct eras of an advanced healthcare system. Anonymized consecutive patient records submitted to TARN UK between 2002 and 2017 by NHS England hospitals were analyzed. Records of patients without a pelvic fracture, or with isolated pelvic fractures (no other serious injury with abbreviated injury scale AIS >2) were excluded. All patients with known outcomes were included and were divided into 2 distinct periods (pre-RTN era: between January 2002 and March 2008 (control group); and RTN era April 2013 to June 2017 (study group)). Data from the transition period from April 2008 to March 2013 were excluded to minimize the effect of variations between the developing networks and MTCs during that era. Overall, the study group included 10,641 patients, whereas the control group was 3152 patients, with a median age of 52.4 and 35.1 years and an ISS of 24 and 27 respectively. A systolic blood pressure below 90mmHg was observed in 7.2% of patients in the study group and 10.4% in the control group. A significant increase of the median time to death (from 8hrs to 188hrs) was observed between the two eras. The cumulative mortality of severely injured patients with pelvic fractures decreased significantly from 17.8% to 12.4% (p<0.0001). The recorded improvement of survivorship in the subgroup of severely injured patients with a pelvic fracture (32% lower in the post-RTN than in the pre-RTN period: OR 1.32 (95% CI 1.21 - 1.44), following the first 5 years of established regional trauma networks in NHS England, is encouraging, and should be attributed to a wide range of factors that translate to all levels of trauma care.

Keywords: Major trauma; Mortality; NHS England; Outcome; Pelvic fractures; Regional trauma networks; TARN.