Database Development And Multicentral Epidemiological Study Of Pelvic Trauma In Hunan Province

Objective:To investigate the content and structure of a database representing the state of pelvic trauma research and cater for prospective registration of pelvic trauma data in Hunan province. To provide a theoretical basis for the standardization of pelvic trauma comprehensive treatment in Hunan, this study is focused on discovering the problems both of prehospital EMS and treatment status in hospitals and mastering the epidemiological characteristics of patients with pelvic trauma.Methods:1. Scientific and rational content and structure of the pelvic trauma database was investigated and formulated by analyzing and consulting the experiences of existing trauma database in China and foreign countries. The pelvic trauma database was formated based on the PostgreSQL and the application was developed with java language.2. Pelvic trauma survey collaborative group of Hunan province was founded, also the epidemiological survey questionnaire was designed. A prospective, multicenter investigation of patients with pelvic trauma was initiated after training. All of the information was stored in the pelvic trauma database. The useful information was exported from the database and analyzed by sppss18.0one year later.Results:Chapter Ⅰ:Development of pelvic trauma database1. We have developed a new database that could relatively represent the comprehensive pelvic trauma care process. The content of the database includes general patient information, pre-hospital condition, injury severity, hospital transfering, emergency admission, hospital care, diagnosis and scoring, complication and comorbidity, care quality and discharge.2. Based on the content and structure of the database, a registery and administration system of pelvic trauma database was developed with the functions of security verification, data administration, output of data and statistical analysis.Chapter Ⅱ:Basic epidemiological characteristics1. General information. Male and female ratio was1.40:1. Average age was44.16±17.41years old, there is no significant difference of all ages (x2=11.738, p=0.110). Farmers are the main injury groups (accouting for37.13%of the total patients), followed by the workers (accounting for12.9%). Patients with high school education and lower level accounted for76.88%.The numbers of cases in January, February, November and December for the year were bigger, relatively smaller in the middle. The time of pelvic trauma was concentrated on the time segments of9:00to13:00and15:00to21:00.2. Trauma mechanism:Pelvic trauma occurred mainly in the ordinary road (48.86%), home (20.85%) and construction site (14.98%). Traffic accidents, falling from height and falling from the same level are the three major reasons (accounting for28.66%,51.47%and7.82%respectively). Each trauma causes between genders are significantly different(Χ2=36.501, P<0.001). Patients falling from the same level accounted for7.82%, with an average age of62.17±15.93years, the difference with others was significant (P<0.01). Pedestrians got injured most commonly (48.1%), followed by motorcyclists (20.89%) and motor vehicles (19.62%). Of all the traffic accident, motor vehicle accounted for71.2%and related to the motorcycle accounted for13.6%.Chapter Ⅲ Prehospital emergency medical services1. Call for help at the scene:Patients himself/herself accounted for32.14%, followed by witnesses(26.53%) and companions(23.21%).81.5%patients call for help by cell phone. Cellphone number120was the first choice(49.2%), followed by friends (33.1%) and cellphone number110(7.4%). The average time of receiving non-professional emergancy help from the first witnesses was26.86±38.38min. The time to get the second level emergency (such as ambulances) was59.48±65.43min. 2. First aid on-site:76.3%of the patients’s limbs were fixed,55.3%of the patients’s airway were kept open and38.4%of the patients were binded by pressure bandage.65.4%of the patients received first aid from ambulance emergency personnels, followed by relatives(44.2%), perpetrators(21.6%), witnesses and passersby (16.9%).3. Carrying and transferring:65.54%of the patients were carried by stretcher, while25%were by hand. Ambulance transport after injury accounted for79.21%, followed by taxis and passing vehicles (4.95%respectively).4. The first hospital:45.9%of the patients were transfered firstly to municipal hospital,30.16%of the patients were to county-level hospitals, followed by township or community hospital(12.13%).5. Referral reasons:60.6%of patients were transferred because of the hospital’s inability,38.8%of patients were transferred for their families’requires.6. Time from injured to the investgated hospital:the elapsed time was32.92±104.56h (0.17-1296h), with a median of4h,60%of the patients within6h,70%of the patients within10h while80%of the patients within24h.Chapter IV treatment in hospitals and prognosis:1. Vital signs:SBP was115.68±23.71mmHg (49-199mmHg) in emergency room and119.23±22.43mmHg (60-190mmHg) in ward. Heart rate was93.61±20.61/min(40-180/min) in emergency room and87.78±17.947/min (56-155/min) in ward. The RR was20.46±2.427/min (12-30/min).20.1%of the patients were with shock.2. First aid measures:The top three methods were blood transfusion (25.41%), debridement sewn (22.48%) and useing dehydrating agent (16.61%);7.17%of the patients were operated by endotracheal intubation or incision.3. Transfusion-related matters:The rate of blood transfusion was43.6%, male to female ratio was1.9:1, the difference was significant (P <0.05). Average age of patients with blood transfusion was43.61±16.76years (1-78years) old. Average transfusion was1809.64ml (200-14320ml). Anemia due to preoperative blood loss accouting for51.5%and blood transfusion due to intraoperative accounted for78.2%. PRBC transfusion accounted for97.74%of the patients with blood transfusion, followed by FFP (48.87%). The rates of blood transfusion of pelvic fracture patients combined such as urinary system damage, a large area of skin laceration or rectal injuries were85%,75%and75%respectively. Patients with combined injuries may have greater probability of blood transfusion (Χ2=26.86, P<0.001). The transfusion rate was24%of A-type fracture,44%of B-type fracture and55%of C-type fracture. The severity of the fracture classification was ralated with transfusion rate (Χ2=44.329, P <0.001). The rate of transfusion of closed pelvic fractures was41%, while it was75%of the open pelvic fractures. The difference was also significant(Χ2=8.549, P<0.05). 4. ISS:The rate of ISS≥16was10%of the A-type fractures,27.4%of B-type fractures and95.2%of C-type. The ISS of different types of fractures was significently different(Χ2=173.34, P<0.001). Patients with ISS≥16have higher proportions in more serious fracture types (Χ2=136.58, P<0.001). Mean ISS of all patients was16.09±9.1. Mean ISS of shock patients was21.95±9.05while mean ISS of patients without shock was12.77±7.97, the difference was statistically significant (t=-7.694, P<0.001). Mean ISS of open pelvic fractures was23.95±9.74while the mean ISS of closed pelvic fractures was14.01±8.71, the difference was statistically significant (t=-4.895, P<0.001).5. Fracture site of pelvis:pubic bone (80.72%), iliac (43.79%), sacral (31.70%) were the three most commonly injuried site.6. Associated injuries:The top three associated injuries were limb fractures or ligament injury (56.49%), subcutaneous hematoma (35.56%), rib fractures (29.71%).33.77%of the patients have been detected with peritoneal hematoma at the first diagnose. The rate of urethral injury was10.1%, and83.87%of the cases were diagnosed by catheterization. The rate of bladder injury was6.19%,36.84%of the cases were found by catheterization, and another36.84%were by the bladder retrograde angiography. The rate of rectal injury was0.97%, and all of those were found by digital rectal examination. The rate of sacral plexus injury was7.49%. In women, the rates of perineal injuries, vaginal injuries, perineum and vagina injuries were 3.91%,1.95%and1.95%.7.5%of pelvic fractures patients was combined with a large area of skin avulsion. Floating hip injury accounted for9.44%of the total patients.7. Treatment:Non-surgical treatment accounted for66.12%, while surgical treatment accounted for33.88%.74.04%of the patients with pelvic surgery aquired open reduction and internal fixation,18.27%of the operated patients aquired closed reduction and external fixation surgery and7.69%with bone distraction. The rates of surgical treatment of type A, B and C were14.55%,36.28%and55.95%respectively, also the difference was statistically significant (Χ2=36.9, P<0.001). The rate of surgical treatment of blunt pelvic fracture was31.71%while it was65.00%of the open pelvic fracture.The difference was statistically significant (Χ2=6.71, P=0.01<0.05). The average time from the injury to the first pelvic fracture surgery was204.78h (2-940h).87.4%of pelvic fractures operations were finished by chief surgeons or vice chief surgeons, and12.6%of surgeries were done by the attending surgeons.49.5%of the patients had surgeries except pelvis.8. Monitoring environment:21.82%of the patients had been sent to intensive care unit (ICU and NICU).77%of those patients owned ISS more than16and the difference was significent comparing with those in general ward.(Χ2=41.68, P<0.001)9. Complications:the top two complications were infection (14.98%) and shock (9.12%). 10. Discharge:It was estimated that32.6%of the patients will own sequelae. The top three were limp, leg significantly shorter and urethral stricture.22.14%of the patients left hospitals by themselves. The average hospital stay was34.11days.73.33%of the patients were followed up at outpatient after discharge while23.16%were transferred to other hospitals for rehabilitation.11. Expenditures:The treatment costs of46.43%patients was paid by the wreckers and45.63%was paid by patients themselves. The average total cost of treatment was RMB49,123.94.Conclusion:1. We have established a whole life cycle pelvic trauma database containing pre-hospital care for the first time in china.1) It was proved to be functional, practical, user-friendly and working well.2) It facilitated the collection and management of pelvic trauma data. It also was useful for pelvic trauma epidemiological analysis, and accumulated experience for future clinical databases study.2. This epidemiological study of Hunan province showed:1) The major cause of pelvic trauma was road traffic injury, young male farmers and migrant workers are the major pelvic trauma patients.2) The pre-hospital care, treatment in hospital and rehabilitation level of pelvic trauma in Hunan province still have a long way to go comparing with developed countries:The training of the first witnesses was insufficient; Pre-hospital emergency took a long time and didn’t use commercial pelvic belt; The transfusion was unreasonable in some hospitals arid the multiple injury proportion of pelvic fracture injuries was higher than those reported abroad; Some orthopaedic surgeons were not familiar with the classifications of pelvic fracture, trauma ratings and the choosing of treatment methods for pelvic fractures were not standardized also; High hospital costs, long hospital stay, insufficient and nonstandard rehabilitation exercises were also existing.