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Predictors of bleeding from stable pelvic fractures
Athanasios Bramos1, George C Velmahos, Umar M Butt
1Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Archives of Surgery (Chicago, Ill. : 1960)
|December 22, 2010
Summary
Significant bleeding from stable pelvic fractures is uncommon but predictable. Low hematocrit, pelvic hematoma on CT, and low systolic blood pressure are key indicators for potential bleeding in SPF patients.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Emergency Medicine
Background:
- Stable pelvic fractures (SPFs) infrequently cause significant bleeding (SigBleed).
- Predictive indicators for SigBleed in SPFs are needed for timely intervention.
- Early identification of SigBleed risk can improve patient outcomes.
Purpose of the Study:
- To identify simple, bedside indicators for predicting significant bleeding in patients with stable pelvic fractures.
- To assess the association between clinical and imaging findings and SigBleed in SPFs.
Main Methods:
- Retrospective review of medical records from an academic level 1 trauma center.
- Analysis of 391 patients with SPFs, categorizing them by bleeding status.
- Univariate and multivariate analysis to identify independent predictors of SigBleed.
Main Results:
- Only 5% of SPFs were associated with SigBleed.
- Independent predictors for SigBleed included hematocrit ≤30%, pelvic hematoma on CT, and systolic blood pressure ≤90 mm Hg.
- The presence of all three predictors indicated 100% likelihood of SigBleed.
Conclusions:
- SigBleed from SPFs is rare but reliably predicted by specific clinical and imaging findings.
- Admission hematocrit, pelvic hematoma on CT, and systolic blood pressure are valuable bedside indicators.
- These indicators can guide monitoring and intervention decisions for patients with SPFs.
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