Gurd described clinical features that could be used to identify a patient with the fat embolism syndrome occurring after long bone or pelvic fracture. Early recognition of the syndrome allows for prompt institution of respiratory support and other interventions that can reduce morbidity and mortality.


Onset after the injury is variable, with a symptom free period ranging from a few hours to rarely over 72 hours.

Major criteria:

(1) petechial rash

(2) respiratory symptoms (hypoxia, cyanosis and/or tachypnea) AND bilateral signs AND positive radiographic changes (diffuse bilateral infiltrates)

(3) cerebral signs (delirium, restlessness, confusion, altered mental status) unrelated to head injury or any other condition


Minor criteria:

(1) tachycardia (> 110 beats per minute)

(2) pyrexia (body temperature > 38.5°C)

(3) retinal changes on fundoscopic examination (presence of petechiae and/or fat)

(4) urinary changes (anuria, oliguria and/or fat globules)

(5) sudden unexplained drop in hemoglobin level

(6) sudden unexplained drop in platelet count (sudden onset of thrombocytopenia)

(7) elevated erythrocyte sedimentation rate (ESR)

(8) presence of fat globules in the sputum


Diagnosis (from Androvulakis and Demetriades):

(1) at least 1 major criteria AND at least 3 minor criteria; Gurd used at least 4 minor criteria (top of page 733)

(2) at least 2 major criteria AND at least 2 minor criteria


Differential diagnosis:

(1) thromboembolism

(2) sepsis



• A small amount of fat embolization may be subclinical.


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