Smith et al evaluated patients with hemodynamically unstable pelvic fractures and identified risk factors for mortality that can be identified soon after the hospital admission. These can help identify a patient who may benefit from more aggressive management. The authors are from the University of Colorado in Denver.


Patient selection:

(1) age >= 14 years

(2) in hemodynamic shock on admission

(3) unresponsive to initial fluid resuscitation


Common causes of mortality in these patients:

(1) massive exsanguination

(2) multiple organ failure


Risk factors for mortality:

(1) higher age

(2) higher injury severity scale (ISS)

(3) lower revised trauma score (RTS)

(4) higher red blood cell transfusion needs during the first 24 hours


Cutoffs for increased risk:

(1) age > 60 years (results, page 31)

(2) ISS: suggest >= 37 (based on Table 3, page 34)

(3) RTS: suggest <= 5 (based on Table 3, page 34)

(4) 24 hour blood transfusion: suggest >= 9 (based on Table 3, page 34)



• A lower Glasgow coma score is associated with mortality (Table 3, page 34).

• The beta coefficients for the risk factors are given in Table 7 but no intercept is given. The beta coefficients are 0.072 for age, 0.044 for ISS, 0.086 for blood transfusion, and -0.639 for RTS.


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