Study design

A retrospective cohort study was conducted for all patients who sustained traumatic pelvic injuries and were admitted at two trauma centers: Hamad Trauma Center (HTC), the level 1 national trauma center in the state of Qatar, and BG Trauma Center Ludwigshafen, Germany, (level 1 trauma center) between January 2010 and June 2016. The final analysis comprised of all patients with traumatic pelvic fractures (n = 1814). We have excluded patients presented with cardiac arrest on arrival at the hospital and those without pelvic fracture. The study was approved by the institutional review board (IRB) of the Medical Research Center at Hamad Medical Corporation [HMC IRB# 14175/14 & 16395/16; BG IRB# 837.500.17 (11334)] with a waiver of informed consent. In Qatar, data were retrospectively obtained from a prospectively maintained trauma registry database of the HTC. HTC is a level 1 accredited center by the Accreditation Canada; it is a tertiary hospital with a dedicated trauma team of surgeons and intensivist, immediate access to care, operating theater, interventional radiology, massive transfusion protocol, and advanced prehospital care. HTC data repository with uniform data elements are reporting to the National Trauma Data Bank (NTDB) and the Trauma Quality Improvement Program (TQIP) of the American College of Surgeons-Committee on Trauma (ACS-COT). The HTC is the only tertiary care facility in the country to which around 1500–1700 trauma patients are admitted annually. Therefore, the data obtained from the Qatar trauma registry are nationally representative which covers a population of approximately 2.6 million. The German center participates in the German Trauma [2018: 193 trauma room admissions, 125 patients injury severity score ((ISS) > 16)] as well as the pelvic injury registry). The German center serves a population of about 1.5 million people in the metropolitan area Rhein-Neckar. The German data were retrospectively obtained from the clinic information system as well as from a prospectively maintained trauma database. The BG Trauma Center Ludwigshafen is a professional accident clinic in Ludwigshafen. The primary focus of this center includes trauma surgery and orthopedics, plastic and reconstructive surgery, and hand and tumor surgery. From 1997, the BG hospital has initiated academic research and teaching, and the management of patients with trauma, hand, plastic, and burn surgery.

The trauma teams assessed all the pelvic trauma patients, and pelvic binder is used whenever indicated. Initial assessment and management are following the ATLS guidelines. All patients get a pelvic X-ray and a CT scan if hemodynamically stable. Patient management is carried out by a multidisciplinary team lead by trauma surgeons and included intensivist, anesthesiologist, orthopedic surgeons, other surgical subspecialties according to the associated injuries, and radiologist.