From Reuters Health Information

Three Markers Predict Significant Bleeding From Stable Pelvic Fracture

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By Rob Goodier

NEW YORK (Reuters) Dec 24 - Stable pelvic fractures rarely cause bleeding that requires an intervention, but when they do, doctors may have three clues, according to new study findings.

The researchers say three things independently predict significant bleeding in this situation: a hematocrit of 30% or lower at the time of hospital admission (OR: 43.93; p<0.001), a pelvic hematoma on a CT scan (OR: 39.37; p<0.001), and systolic blood pressure of 90mm Hg or lower (OR: 18.352; p=0.01).

Out of 391 patients in the study, hip fractures caused significant bleeding in only 5%, and these three risk factors were the only independent indicators found, according to the researchers at the Massachusetts General Hospital who carried out the study.

Significant bleeding occurred in all of the patients who displayed all three of the independent risk factors, and none of those without any.

"If none of the three risk factors is present, the patient can be safely treated in a regular hospital bed or discharged," the researchers wrote in a paper published online December 20 in Archives of Surgery. "If one or two of the risk factors exist, the patient should be monitored in an intensive care environment, and a low threshold for intervention should be maintained. If all of the risk factors exist, the patient should undergo emergent angiography or preperitoneal pelvic packing according to the circumstances."

The research team examined medical records of 465 patients with stable pelvic fractures-all those who were admitted to the level 1 academic trauma center at Massachusetts General Hospital from 2002 to 2007. They excluded 74, most of whom did not have a pelvic CT scan. Then they divided the remaining 391 into three groups: 280 (72%) who did not have significant bleeding, 90 (23%) who had significant bleeding that was not caused by a hip fracture, and 21 (5%) who had significant bleeding caused by a hip fracture.

"A stable pelvic fracture is often dismissed as a source of significant bleeding, possibly resulting in delays of care," the researchers wrote. "For those few patients with stable pelvic fractures and a high likelihood of significant bleeding, early intervention or close monitoring is essential."

Source: http://link.reuters.com/ker63r

Arch Surg 2010