Pelvic fractures in a level I trauma center: a test case for the efficacy of the evolving trauma system in Israel.

BACKGROUND Pelvic fracture is a severe and life-threatening injury that requires treatment by a dedicated team. One of the goals of a nationwide trauma system is to provide appropriate medical care for such injuries. OBJECTIVES To use pelvic fractures as a test case for the efficiency of the Israeli trauma system, as reflected in the experience of our medical center. METHODS Data were obtained from the medical charts of all cases of pelvic fractures admitted to our medical center between 1987 and 1999. We obtained demographic data, information on the cause of injury, fracture classification, co-injuries and Injury Severity Score, treatment strategies, and mortality rate. RESULTS Altogether, 808 patients with pelvic injuries were treated in our medical center. The most common cause of injury was motor vehicle accidents (51%). Pelvic fractures without acetabular involvement were diagnosed in 58% of patients and isolated acetabular fractures in 32%, while 10% sustained combined injuries to the pelvic ring and the acetabulum. The overall rate of operative stabilization was 34%. The majority of patients had associated injuries, mostly additional musculoskeletal injuries. Altogether, 13% were referred from Level II/III trauma centers. We observed an increase in the total number of local admissions, in the percentage of referred patients and in the percentage of operated patients during the study period. The observed mortality rate was 5%. CONCLUSIONS Our results show a more than twofold increase in the percentage of referred patients following the designation of a Level I trauma center. These referrals are due not only to the designation as a Level I trauma center, but also to the presence of a dedicated team of pelvic fracture specialists, available 24 hours a day. In addition, a larger percentage of patients undergo surgery for internal fixation of pelvic fractures, in accordance with current worldwide trends.