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Predictors of Demetriades et al for Major Blood Transfusion in a Patient with a Pelvic Fracture

Description

Demetriades et al identified factors associated with the need for major blood transfusion in a patient with a pelvic fracture. These can help to identify a patient who may have greater blood needs. The authors are from the University of Southern California in Los Angeles.


 

Patient selection: trauma patient with pelvic fracture

 

Outcome: major blood transfusion, defined as > 2,000 mL blood

 

Parameters (with significant p values):

(1) Injury Severity Score (ISS)

(2) pelvis AIS

(3) age in years

(4) therapeutic angiogram

Parameter

Finding

OR

ISS

<= 15

1

 

16 to 25

2.9

 

>= 26

5.2

pelvis AIS

2

1

 

3

1.7

 

4

2.2 (*)

 

5

4.7

age of the patient

<= 55 years of age

1

 

> 55 years of age

1.9

therapeutic angiogram

no

1

 

yes

3.2

 

where:

• The odds ratio for a pelvic AIS 4 is 1.1 in Table 7, which is less than the odds ratio for ASI 3. The OR for AIS <= 3 vs >= 4 is 2.2, which is used here.

• A therapeutic angiogram is more likely to be done in someone thought to have significant bleeding.

 

cumulative odds ratio for major blood transfusion =

= PRODUCT(odds ratios for each parameter)

 

Interpretation:

• minimum cumulative OR: 1

• maximum cumulative OR: 149

 


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