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Abstract：
In 2017, a novel classification for pelvic injuries was established by the World Society of Emergency Surgery (WSES). We validated its effectiveness using nationwide real-world data. The roles of associated vascular injury and open fracture in this system were also evaluated.
Patients with pelvic fractures in the National Trauma Data Bank 2015 dataset were retrospectively studied. First, the mortality rates were compared by WSES classification. Second, independent predictors of mortality were evaluated using a multivariate logistic regression model. Patients with and without associated vascular injuries and the same hemodynamic and pelvic ring stability statuses were compared. Patients with associated vascular injuries were compared to the proportion of nonsurvivors and survivors with unstable pelvic ring injuries. Third, the outcomes were compared between patients with open pelvic fracture and closed pelvic fracture in the mild, moderate and severe WSES classes.
During the 12-month study period, 44,163 blunt pelvic fracture patients were included. The mortality rates were 1.8%, 3.8% and 10.6% for the mild, moderate and severe WSES classes, respectively (p < 0.001). MLR analysis showed that unstable pelvic ring injury did not significantly affect mortality (p = 0.549), whereas open pelvic fracture and associated vascular injury were independent predictors of mortality (odds of mortality: open pelvic fracture 1.630, p < 0.001; associated vascular injury 1.602, p < 0.001). Patients with associated vascular injuries showed that there was no significant difference in the proportion of patients with unstable pelvic ring injuries between survivors and nonsurvivors (37.2% vs. 32.7%, p = 0.323). In all three classes, patients with open pelvic fractures had significantly higher mortality rates and infection rates than patients with closed fractures (mortality rates: minor 3.5% vs. 1.8%, p = 0.009, moderate 11.2% vs. 3.3%, p < 0.001, severe 23.8% vs. 9.8%, p < 0.001; infection rates: minor 3.3% vs. 0.7%, p < 0.001, moderate 6.7% vs. 2.1%, p < 0.001, severe 7.9% vs. 2.8%, p < 0.001).
Based on this nationwide study, the WSES guideline provides an accurate and reproducible classification of pelvic fractures. It is recommended that open/closed fractures and associated vascular injuries be evaluated as supplements of the WSES classification.
Patients with pelvic fractures in the National Trauma Data Bank 2015 dataset were retrospectively studied. First, the mortality rates were compared by WSES classification. Second, independent predictors of mortality were evaluated using a multivariate logistic regression model. Patients with and without associated vascular injuries and the same hemodynamic and pelvic ring stability statuses were compared. Patients with associated vascular injuries were compared to the proportion of nonsurvivors and survivors with unstable pelvic ring injuries. Third, the outcomes were compared between patients with open pelvic fracture and closed pelvic fracture in the mild, moderate and severe WSES classes.
During the 12-month study period, 44,163 blunt pelvic fracture patients were included. The mortality rates were 1.8%, 3.8% and 10.6% for the mild, moderate and severe WSES classes, respectively (p < 0.001). MLR analysis showed that unstable pelvic ring injury did not significantly affect mortality (p = 0.549), whereas open pelvic fracture and associated vascular injury were independent predictors of mortality (odds of mortality: open pelvic fracture 1.630, p < 0.001; associated vascular injury 1.602, p < 0.001). Patients with associated vascular injuries showed that there was no significant difference in the proportion of patients with unstable pelvic ring injuries between survivors and nonsurvivors (37.2% vs. 32.7%, p = 0.323). In all three classes, patients with open pelvic fractures had significantly higher mortality rates and infection rates than patients with closed fractures (mortality rates: minor 3.5% vs. 1.8%, p = 0.009, moderate 11.2% vs. 3.3%, p < 0.001, severe 23.8% vs. 9.8%, p < 0.001; infection rates: minor 3.3% vs. 0.7%, p < 0.001, moderate 6.7% vs. 2.1%, p < 0.001, severe 7.9% vs. 2.8%, p < 0.001).
Based on this nationwide study, the WSES guideline provides an accurate and reproducible classification of pelvic fractures. It is recommended that open/closed fractures and associated vascular injuries be evaluated as supplements of the WSES classification.
摘要：
2017年，世界急诊外科学会（WSES）建立了骨盆损伤的新分类。我们使用全国范围的实际数据验证了其有效性。还评估了相关血管损伤和开放性骨折在该系统中的作用。
对2015年国家创伤数据库数据集中的骨盆骨折患者进行了回顾性研究。首先,通过WSES分类比较了死亡率.第二,使用多变量逻辑回归模型评估死亡率的独立预测因子.比较有和没有相关血管损伤的患者以及相同的血流动力学和骨盆环稳定性状态。将相关血管损伤的患者与未幸存者和不稳定骨盆环损伤的幸存者的比例进行比较。第三，比较轻度开放性骨盆骨折和闭合性骨盆骨折患者的结局，中度和重度WSES类。
在12个月的研究期间，包括44,163例钝性骨盆骨折患者。死亡率为1.8%,3.8%，轻度为10.6%，中度和重度WSES课程，分别(p<0.001)。MLR分析显示不稳定骨盆环损伤对死亡率无显著影响(p=0.549),而开放性骨盆骨折和相关血管损伤是死亡率的独立预测因子(死亡率几率:开放性骨盆骨折1.630,p<0.001;相关血管损伤1.602,p<0.001).相关血管损伤患者显示，不稳定骨盆环损伤患者的比例在幸存者和非幸存者之间没有显着差异（37.2％vs.32.7%,p=0.323）。在所有三个班级中，开放性骨盆骨折患者的死亡率和感染率明显高于闭合性骨折患者(死亡率:轻微3.5%vs.1.8%,p=0.009，适中的11.2%与3.3%,p<0.001，严重23.8%vs.9.8%,p<0.001；感染率：轻微3.3%vs.0.7%，p<0.001，适度6.7%与2.1%,p<0.001，严重的7.9％与2.8%，p<0.001)。
根据这项全国性的研究，WSES指南提供了准确且可重复的骨盆骨折分类.建议将开放性/闭合性骨折和相关血管损伤作为WSES分类的补充进行评估。
对2015年国家创伤数据库数据集中的骨盆骨折患者进行了回顾性研究。首先,通过WSES分类比较了死亡率.第二,使用多变量逻辑回归模型评估死亡率的独立预测因子.比较有和没有相关血管损伤的患者以及相同的血流动力学和骨盆环稳定性状态。将相关血管损伤的患者与未幸存者和不稳定骨盆环损伤的幸存者的比例进行比较。第三，比较轻度开放性骨盆骨折和闭合性骨盆骨折患者的结局，中度和重度WSES类。
在12个月的研究期间，包括44,163例钝性骨盆骨折患者。死亡率为1.8%,3.8%，轻度为10.6%，中度和重度WSES课程，分别(p<0.001)。MLR分析显示不稳定骨盆环损伤对死亡率无显著影响(p=0.549),而开放性骨盆骨折和相关血管损伤是死亡率的独立预测因子(死亡率几率:开放性骨盆骨折1.630,p<0.001;相关血管损伤1.602,p<0.001).相关血管损伤患者显示，不稳定骨盆环损伤患者的比例在幸存者和非幸存者之间没有显着差异（37.2％vs.32.7%,p=0.323）。在所有三个班级中，开放性骨盆骨折患者的死亡率和感染率明显高于闭合性骨折患者(死亡率:轻微3.5%vs.1.8%,p=0.009，适中的11.2%与3.3%,p<0.001，严重23.8%vs.9.8%,p<0.001；感染率：轻微3.3%vs.0.7%，p<0.001，适度6.7%与2.1%,p<0.001，严重的7.9％与2.8%，p<0.001)。
根据这项全国性的研究，WSES指南提供了准确且可重复的骨盆骨折分类.建议将开放性/闭合性骨折和相关血管损伤作为WSES分类的补充进行评估。
