Predicting major hemorrhage in patients with pelvic fracture

C. Craig Blackmore, Peter Cummings, Gregory Jurkovich, Ken F. Linnau, Eric K. Hoffer, Frederick P. Rivara

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

BACKGROUND: Pelvic fractures can be an important source of major hemorrhage in victims of blunt trauma. However, no rapid and reliable noninvasive method exists for predicting which subjects will have major hemorrhage. The objective of this study is to use information available upon presentation to the trauma center to develop a clinical prediction rule to identify subjects with pelvic fracture who are at high risk of major hemorrhage. METHODS: A retrospective cohort study was performed on all subjects with pelvic fracture from blunt force mechanism at a single level one trauma center during a 4.3 year period. Chart review identified findings from initial pelvic radiographs and from emergency department care including mechanism of injury, and hemodynamic status. Major hemorrhage was defined by angiographic findings, transfusion requirement and pelvic hemorrhage vaolume. Logistic regression was used to formulate a clinical prediction rule to stratify subjects based on probability of major hemorrhage. RESULTS: Complete data were available on 627 of 783 eligible subjects. Predictors of major hemorrhage included emergency department hematocrit 30 or less, pulse rate of 130 or greater, displaced obturator ring fracture and pubic symphyseal wide diastasis. Combinations of predictors defined groups with probability of major hemorrhage from 1.6% to 66%. CONCLUSIONS: Probability of major pelvic fracture related hemorrhage can be estimated from initial pelvic radiograph, pulse, and hematocrit.

Original languageEnglish (US)
Pages (from-to)346-352
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume61
Issue number2
DOIs
StatePublished - Aug 1 2006
Externally publishedYes

Fingerprint

Hemorrhage
Decision Support Techniques
Trauma Centers
Hematocrit
Hospital Emergency Service
Wounds and Injuries
Emergency Medical Services
Cohort Studies
Retrospective Studies
Heart Rate
Logistic Models
Hemodynamics

Keywords

  • Hemorrhage
  • Pelvic fracture
  • Prediction rule

ASJC Scopus subject areas

  • Surgery

Cite this

Predicting major hemorrhage in patients with pelvic fracture. / Blackmore, C. Craig; Cummings, Peter; Jurkovich, Gregory; Linnau, Ken F.; Hoffer, Eric K.; Rivara, Frederick P.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 61, No. 2, 01.08.2006, p. 346-352.

Research output: Contribution to journalArticle

Blackmore, C. Craig ; Cummings, Peter ; Jurkovich, Gregory ; Linnau, Ken F. ; Hoffer, Eric K. ; Rivara, Frederick P. / Predicting major hemorrhage in patients with pelvic fracture. In: Journal of Trauma - Injury, Infection and Critical Care. 2006 ; Vol. 61, No. 2. pp. 346-352.
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