Title: Mortality and Causes of Death Among Patients with Isolated Limb and Pelvic Fractures
Authors: D. E. Deakin, C. Boulton, C. G. Moran
Source: International Journal of the Care of the Injured 2007; 38, 312-317.
PODIATRIC RELEVANCE:
Little is known about orthopedic trauma morality rates and causes of death as a whole. Many times we encounter patients who present with fractures of the limb and pelvis. Trauma is a leading cause of death among patients. There have been numerous studies that address morality rates and causes of death following specific fractures. The authors of this article state that there is little information about morality rates and causes of death following orthopedic injury. Identifying risk factors and complications associated with the incidence of death following trauma is an important analysis.
METHODS:
In this article 8834 adults were admitted to the author’s hospital between May 2001 and May 2005 with fractures of the limbs and pelvis. This included patients who were admitted under the care of non-orthopedic services. Spinal and head injuries were not included. Patients with polytruams and other major injuries were not included. The only exception to this criterion was hand injuries. The information recorded was collected by independent clerks using a standardized format documenting various details including patient demographics, mechanism of injury, injuries sustained and complications following injury.
RESULTS:
During the 4 year period the 8834 adults who were admitted to the hospital with a fracture; of these 4674 (52.9%) were women and 4160 (47.1%) were men. The most common site of injury was the neck of the femur, accounting for 32.7% of total admissions, followed by injuries to the upper limb (20%). Location of the fracture varied with age, the most common injuries in younger people involved the hand (28%), foot and ankle (28%) and upper limb (24%). The most common injury in the elderly involved the neck of the femur accounting for 67% of admissions of people over 80 years of age. Younger patients (ages 20-40) were most likely to be men and older patients (70-90) were most likely to be women.
Fractures neck of femur was associated with the highest 30 day mortality (11.4%) followed by femoral injuries (5.7%). Morality rates rose in proportion to age. At 1 year after trauma, fractured neck of the femur still showed the highest mortality rate of (33%), followed by femoral fractures (11.4%), which was seen in all age groups. Morality appeared to show the greatest during the first 90 days following trauma for all sites of injury. Majority of inpatient deaths were due to bronchopneumonia (39%), malignancy (11%), ischemic heart disease (11%) and sepsis (7%).
COMMENTS:
The prospective study shows analysis of injury patterns and morality rates of patients over a 4 year period. This study was limited due to lack of information on cause of death among the patients who died following discharge, rather than as inpatients and no detailed analysis on patients with fractures not requiring inpatient admission. Overall factors that appear with increased morality following orthopedic injury include; age, fractured neck of femur in any age group and injury to the femur or pelvis regardless of age.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.