Trends in Isolated Pelvic Fracture and 30-Day Survival during a Recent 15-Year Period: A Nationwide Study of the Japan Trauma Data Bank

Abstract

Background: The epidemiology and treatment of isolated pelvic fracture in Japan are not well understood. This study evaluated epidemiological trends in isolated pelvic trauma and in-hospital survival rates during a recent 15-year period. Methods: This retrospective cohort study analyzed data from the Japan Trauma Data Bank for 2004-2018. Patients of any age with isolated pelvic fracture were grouped according to time period, as follows: 2004-2008 (Phase 1), 2009-2013 (Phase 2), and 2014-2018 (Phase 3). The main outcome was 30-day in-hospital survival rate. The data were analyzed using the chi-square, Kruskal-Wallis, and Mantel Haenszel trend tests. We analyzed change in the main outcome over time in multiple logistic regression analysis fitted with a generalized estimating equation, accounting for within-cluster association. Results: In total, 5,348 isolated pelvic fractures were identified during the study period. There was no significant between-phase difference in proportions of patients who underwent resuscitative balloon occlusion of the aorta or external fixation. The proportion of patients who underwent transcatheter arterial embolization significantly increased with time (p=0.003), as did the survival rate (Phase 1, 77%; Phase 2, 86%; and Phase 3, 91%; p<0.001). The 30-day in-hospital mortality rate was significantly lower in Phase 3 than in Phase 1 and Phase 2, even after adjustment for hospital clustering and other confounders (p<0.01). Conclusions: The 30-day in-hospital survival rate after isolated pelvic fracture improved over a 15-year period in Japan.