Scoring system to predict hemorrhage in pelvic ring fracture

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Radiology

Background:

• Pelvic ring fractures pose significant hemorrhage risks.
• Existing risk factor identification may lack predictive accuracy.
• A predictive scoring system could enhance hemorrhage risk assessment.

Purpose of the Study:

• To identify risk factors for massive hemorrhage (MH) in pelvic ring fractures.
• To develop and validate a novel predictive score for MH in this patient population.

Main Methods:

• Retrospective review of pelvic ring fracture patients (AIS≥3, age≥16) from 2007-2015.
• Exclusion of hemorrhage from other sources requiring transfusion.
• Definition of MH as transfusion of ≥6 RBC units within 24 hours.

Main Results:

• Multivariable analysis identified lactate level, AO/OTA classification, and CT contrast extravasation as significant MH predictors.
• A predictive score was developed: Lactate (>2.5-5.0 mmol/L)=1 pt, (>5.0 mmol/L)=2 pts; Partially stable (B1-B3)=1 pt, Unstable (C1-C3)=2 pts; Pelvic extravasation=4 pts.
• The score demonstrated high predictive accuracy with an AUC of 0.93 (95% CI: 0.89-0.98).

Conclusions:

• A combined scoring system incorporating lactate, AO/OTA classification, and CT extravasation effectively predicts MH in pelvic ring fractures.
• This novel score offers improved accuracy for identifying patients at high risk of massive hemorrhage.