Emergency Medicine

The likelihood of hemorrhage due to pelvic fracture can be estimated from initial pelvic x-ray, pulse, and hematocrit

Pelvic fractures can cause major hemorrhage in victims of blunt trauma. Knowing which patients with pelvic fractures are most likely to have serious arterial hemorrhage can aid early triage and possible transfer to a trauma center with angiography to diagnose and treat the hemorrhage. According to a new study supported by the Agency for Healthcare Research and Quality (HS11291), the probability of hemorrhage in these patients can be estimated based on initial pelvic x-ray, pulse, and hematocrit (percentage of red blood cells in the blood). Craig Blackmore, M.D., M.P.H., of the University of Washington, and colleagues retrospectively reviewed the charts of 627 patients with pelvic fractures from blunt force (mostly motor vehicle crashes). The patients had received care at a level one trauma center during a 4-year period.

A review of their medical charts identified findings from initial pelvic x-rays and from emergency department (ED) care, including mechanism of injury and blood status. Twenty percent of patients had major pelvic hemorrhage, which was defined by angiographic findings, transfusion requirements, and pelvic hemorrhage volume. Predictors of major hemorrhage included ED hematocrit of 30 or less, pulse rate of 130 or greater, x-ray evidence of displaced (1 cm or more) obturator ring fracture, and x-ray evidence of diastasis of the pubic symphysis of 1 cm or more. Age and mechanism of injury were not important predictors of arterial hemorrhage.

The final four-factor prediction rule was able to stratify pelvic fracture patients into groups with probabilities of major hemorrhage ranging from less than 2 percent for no predictors to over 60 percent for three or more predictors. For example, a patient with a displaced obturator ring fracture, hematocrit of 25, and pulse of 142 was predicted to have a 66 percent probability of major pelvic hemorrhage.

See "Predicting major hemorrhage in patients with pelvic fracture," by Dr. Blackmore, Peter Cummings, M.D., M.P.H., Gregory J. Jurkovich, M.D., and others, in the August 2006 Journal of Trauma 61, pp. 346-352.

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