Blackmore et al identified risk factors predicting major hemorrhage in a patient with a pelvic fracture. This can help identify a patient who may require more aggressive fluid and surgical management. The authors are from the University of Washington in Seattle.
Criteria for major pelvic hemorrhage - one or more of the following:
(1) arterial extravasation seen on angiography
(2) large pelvic hematoma identified on CT scan
(3) large transfusion requirement in the absence of any other source of hemorrhage
Parameters:
(1) displaced obturator ring fracture
(2) displaced pelvic pubic symphysis
(3) hematocrit
(4) pulse
|
Parameter |
Finding |
Points |
|
displaced obturator ring fracture |
none |
0 |
|
|
< 1 cm |
0 |
|
|
>= 1 cm |
1 |
|
displaced pubic symphysis |
none |
0 |
|
|
< 1 cm |
0 |
|
|
>= 1 cm |
1 |
|
hematocrit |
> 30% |
0 |
|
|
<= 30% |
1 |
|
pulse |
< 130 beats per minute |
0 |
|
|
>= 130 beats per minute |
1 |
number of risk factors =
= SUM(points for all 4 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 4
• The risk of major hemorrhage increases with the number of risk factors present.
|
Number of Risk Factors |
Probability of Major Hemorrhage |
|
0 |
1.6% |
|
1 |
14% |
|
2 |
46% |
|
3 or 4 |
66% |
Performance:
• The maximum Youden index was with >= 2 predictors, with sensitivity 75% and specificity of 83%.
Specialty: Clinical Laboratory, Surgery, general, Anesthesiology, Emergency Medicine, Critical Care
ICD-10: ,
