الفهرس 
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Abstract
This study was conducted as a tool-assessment study to determine and assess the prognostic predictors of pelvic vascular injuries in patients with pelvic fractures from major blunt trauma.
Forty six patients with pelvic fractures from major blunt trauma will be recruited to the study arriving to department of emergency, Suez Canal University Hospital.
Data were collected from questionnaire including; personal data of the studied patients and full medical history, clinical examinations, outcome measures (POSSUM score), laboratory and imaging studies
Patients underwent surgical interventions or further investigations based on the conventional standards for interventions and the POSSUM score were compared with the results of the conventional standards interventions for assessment of score validity. All patients were followed up during conservative, operative and post-operative periods in the hospital for interpretation the predictive score of mortality and morbidity.
The mean age of the patients was 41.7±13.9 years with the higher frequency age group of 30-50 years (47.8%). There was higher frequency of males than females in the studied patients (69.6% versus 30.4%, respectively).
The most frequent type of fracture was anterior compression (50%) followed by lateral compression (30.4%). The least frequent type was complex fracture (4.3%). The majority of the patients had motor car accident (91.3%) and the minority of them fall from height (2.2%). The most frequent injuries were abdominal injuries (34.8%) followed by extremity injuries (32.6%). The least frequent injuries were spinal cord injuries (2.2%).
The mean SBP of the patients was 95.8±10.6 mmHg, the mean DBP of the patients was 63.9±8.4 mmHg, and the mean heart rate of the patients was 109.4±16.1 beat/minute. The majority of had Glasgow coma scores ≥15 (58.7%) and the minority of them had scores ≤8 (6.5%). The majority of patients had normal sodium and potassium (65.2% and 89.1%, respectively). The most frequent hemoglobin levels in the studied patients was ≤9.9 g/dl (37%), followed by 10-11.4 g/dl (34.8%).
About 35% of the patients had pelvic collection; 19.6% had mild collection, 8.7% had moderate collection and 6.5% had huge collection.
The majority of the patients had minor-major operations (n=27, 58.7%), while 41% (n=19) of them had conservative management with no operative intervention. Operative timing was elective in most of the cases (63%). The blood loss during operation was ≥1000 ml in 66.7% of the patients.
The majority of the patients (n=32, 69.6%) had minor complications, while 15.2% (n=7) of them admitted to ICU for life-threating conditions and/or died and another 15.2% (n=7) of them had no complications at all.
The mean POSSUM physical score of the all the studied patients (n=46) was 24.39±7.63, while the mean POSSUM operative score of the patients who had operative intervention (n=27) was 19.8±5.62. The frequency of patients with high probability of morbidity (>50%) was 54.3%, while the frequency of patients with high probability of mortality (>50%) was 15.2%.
Significant predictors of vascular injuries according to CT scan include age, male gender, lower GCS scores, occurrence of hypotension, mortality rate, higher physical POSSUM scores, presence of U/S collection, type of management, higher SBP and DBP POSSUM scores, presence of abdominal injuries, and poor outcome.
Significant predictors of poor outcome include lower GCS scores, higher hemoglobin POSSUM scores, mortality rate, higher physical, morbidity, and mortality POSSUM scores, presence of U/S collection, type of management, higher SBP and DBP, POSSUM scores, presence of abdominal injuries, and CT findings.
The optimal cutoff point of POSSUM score to predicate outcome was measured (≤35) with a sensitivity of 100%, specificity of 80%, +PV of 94% and -PV of 100%.