Burden of pelvis fracture: a population-based study of incidence, hospitalisation and mortality.

UNLABELLED: The objective of this study was to describe the incidence and consequences of pelvic fractures in a community cohort. The incidence of pelvic fractures increases with age with a protective effect of higher body mass index. Almost 60% of those with a pelvic fracture required an inpatient stay, with a median of 9 days. There was a higher 3-year mortality in those admitted (17%) vs. those not admitted (6.3%). Given the substantial health burden, further work is required to identify the optimal post-fracture therapeutic strategy to improve outcomes. INTRODUCTION: The burden of pelvis fractures is projected to increase, but there is a paucity of community-based studies describing rates, mortality and future fracture risk. We therefore estimated the age, gender and BMI-specific incidence of pelvis fracture in Catalonia (North-East Spain), and assessed hospital stay and mortality following fracture. METHODS: The SIDIAP(Q) database contains validated clinical information from computerised medical records of a representative sample of 30% of the population of Catalonia. We conducted a retrospective cohort study including all subjects aged ≥ 40 in SIDIAP(Q) and linked to the regional Hospital Admissions Database from 2007 to 2009. Pelvis fractures were ascertained using ICD-10 codes. Incidence and mortality rates were calculated. RESULTS: A total of 1,118,173 patients (582,820 women) were observed for 3 years and 1,356 had a pelvic fracture. The rate for pelvic fracture was 4.35/10,000 person-years (pyar) [95% CI 4.13-4.59] (men-2.73 [2.48-3.01]; women-5.82 [5.46-6.20]). This increased with age, peaking in those over 90 years: 29.41 [25.74-33.59]. Higher BMI was protective (HR 0.75 per SD BMI; [0.69-0.82]). Moreover, 59.1% of fractured patients were hospitalised with a median (IQR) stay of 9 (5-16) days, and after the 3-year follow-up 13.9% died (mortality rate 10.7/100 pyar [9.3-12.3]) with higher rates in those hospitalised (17.0%). CONCLUSIONS: Pelvic fractures are associated with high rates of hospitalisation and mortality. Given this, further work is required to identify the optimal post-fracture therapeutic strategy to improve outcomes in this elderly patient group.

[Angioplasty for acute coronary syndromes in the era of the stent]. / Papel de la angioplastia en los síndromes coronarios agudos en la era del stent.

Pharmacological treatment frequently stabilizes symptoms of patients with acute myocardial ischemia. However, significant quiescent residual stenosis normally persists and leads to rethrombosis. Since rethrombosis produces reischemia and has a deleterious impact on initial and long-term prognosis in these patients, definitive normalisation of local flow assured through deactivation treatments and complete passivation of quiescent residual stenosis in an inert plaque should be a main priority in modern treatment of acute coronary ischemia. Considering the negative influence of significant stenosis on rethrombosis, and that the normalization has a clear antithrombotic effect of flow, routine elimination of residual stenosis by means of angioplasty should prevent rethrombosis and its side effects. Nevertheless, according to trials carried out previous to the most relevant progresses in the field of interventional cardiology, the advantage of this strategy over the conservative treatment has not been clearly demonstrated. Coronary stenting produces a real normalisation of flow and lumen which prevents local thrombosis. In concordance with these facts, recent evidence indicates a substancial clinical benefit of stenting in very thrombogenic acute settings, such as primary angioplasty or refractory acute coronary angina. Presumably, routine stenting also benefits initial and long-term prognosis of other subsets of unstable patients, especially those with thrombolysed myocardial infarction and stabilized patients with acute ischemia without ST-segment elevation. To demonstrate this new trials are needed to compare the efficacy of conservative and interventional approaches that incorporate the advances of each strategys. Until new data are available on these studies, the treatment of acute coronary ischemia should be tailored to each patient and no out-dated recommendation should be given or accepted.