Starr et al evaluated patients with a pelvic fracture causing disruption of the pelvic ring. They identified risk factors associated with the need for blood transfusion. The authors are from the University of Texas Southwestern Medical Center in Dallas and the University of Oxford in England.


Risk factors for blood transfusion:

(1) older age

(2) shock on arrival at the hospital (systolic blood pressure < 90 mm Hg)

(3) low systolic blood pressure

(4) lower revised trauma score (RTS, which ranges from 0 to 12)

(5) negative base deficit (indicating metabolic acidosis)



• Cutoffs for the above factors were not given in the paper.

• Based on data for mortality (Table 8), we will use the following in the implementation: age >= 50 years, systolic blood pressure < 100 mm Hg, base deficit < -6.5, revised trauma score < 12.

• Using a low systolic blood pressure and shock on arrival seems redundant. It might make more sense if the low systolic blood pressure persists after the initial resuscitation. The RTS also incorporates systolic blood pressure.


For patients with lateral compression fractures, blood use increased with greater fracture severity (blood use for LC3 > LC2 > LC1).



• The average blood usage during the first 24 hours after injury was 3 units of packed RBCs.

• Patients who died were transfused more, receiving an average of 11 units more than those who survived.


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