The application of the WSES classification system for open pelvic fractures-validation and supplement from a nationwide data bank

Pei-Hua Li; Ting-An Hsu; Yu-Chi Kuo; Chih-Yuan Fu; Francesco Bajani; Marissa Bokhari; Justin Mis; Stathis Poulakidas; Faran Bokhari

doi:10.1186/s13017-022-00434-y

The application of the WSES classification system for open pelvic fractures-validation and supplement from a nationwide data bank

World J Emerg Surg. 2022 May 27;17(1):29. doi: 10.1186/s13017-022-00434-y.

Authors

Pei-Hua Li¹, Ting-An Hsu¹, Yu-Chi Kuo¹, Chih-Yuan Fu^{2

3}, Francesco Bajani⁴, Marissa Bokhari⁴, Justin Mis⁴, Stathis Poulakidas⁴, Faran Bokhari⁴

Affiliations

¹ Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
² Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan. drfu5564@gmail.com.
³ Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA. drfu5564@gmail.com.
⁴ Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA.

Abstract

Background: Open pelvic fractures are rare but complex injuries. Concomitant external and internal hemorrhage and wound infection-related sepsis result in a high mortality rate and treatment challenges. Here, we validated the World Society Emergency Society (WSES) classification system for pelvic injuries in open pelvic fractures, which are quite different from closed fractures, using the National Trauma Data Bank (NTDB).

Methods: Open pelvic fracture patients in the NTDB 2015 dataset were retrospectively queried. The mortality rates associated with WSES minor, moderate and severe injuries were compared. A multivariate logistic regression model (MLR) was used to evaluate independent factors of mortality. Patients with and without sepsis were compared. The performance of the WSES classification in the prediction of mortality was evaluated by determining the discrimination and calibration.

Results: A total of 830 open pelvic fracture patients were studied. The mortality rates of the mild, moderate and severe WSES classes were 3.5%, 11.2% and 23.8%, respectively (p < 0.001). The MLR analysis showed that the presence of sepsis was an independent factor of mortality (odds of mortality 9.740, p < 0.001). Compared with patients without sepsis, those with sepsis had significantly higher mortality rates in all WSES classes (minor: 40.0% vs. 3.1%, p < 0.001; moderate: 50.0% vs. 9.1%, p < 0.001; severe: 66.7% vs. 22.2%, p < 0.001). The receiver operating characteristic (ROC) curve showed an acceptable discrimination of the WSES classification alone for evaluating the mortality of open pelvic fracture patients [area under curve (AUC) = 0.717]. Improved discrimination with an increased AUC was observed using the WSES classification plus sepsis (AUC = 0.767).

Conclusions: The WSES guidelines can be applied to evaluate patients with open pelvic fracture with accurate evaluation of outcomes. The presence of sepsis is recommended as a supplement to the WSES classification for open pelvic fractures.

Keywords: Blunt abdomen trauma; Open pelvic fracture; WSES.

MeSH terms

Fractures, Open*
Humans
Pelvic Bones* / injuries
Pelvis
Retrospective Studies
Sepsis*