Abstract
BackgroundPelvic bone fractures are one of the biggest challenges faced by trauma surgeons. Especially, the presence of bleeding and hemodynamic instability features is associated with high morbidity and mortality in patients with pelvic fractures. However, prediction of the occurrence of arterial bleeding causing massive hemorrhage in patients with pelvic fractures is difficult. Therefore, the aim of this study was to develop a nomogram to predict arterial bleeding in patients with pelvic bone fractures after blunt trauma.MethodsThe medical records of 1404 trauma patients treated between January 2013 and August 2017 were retrospectively reviewed. Patients older than 15 years with a pelvic fracture due to blunt trauma were enrolled (n = 148). The pelvic fracture pattern on anteroposterior radiography was classified according to the Orthopedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen (OTA/AO) system. Multivariable logistic regression modeling was used to determine the independent risk factors for arterial bleeding. A nomogram was constructed based on the identified risk factors.ResultsThe most common pelvic fracture pattern was type A (58.8%), followed by types B (34.5%) and C (6.7%). Of the 148 patients, 28 (18.9%) showed pelvic arterial bleeding on contrast-enhanced computed tomography or angiography, or in the operative findings. The independent risk factors for arterial bleeding were a type B or C pelvic fracture pattern, body temperature < 36 °C, and serum lactate level > 3.4 mmol/L. A nomogram was developed using these three parameters, along with a systolic blood pressure < 90 mmHg. The area under the receiver operating characteristic curve of the predictive model for discrimination was 0.8579. The maximal Youden index was 0.1527, corresponding to a cutoff value of 68.65 points, which was considered the optimal cutoff value for predicting the occurrence of arterial bleeding in patients with pelvic bone fractures.ConclusionsThe developed nomogram, which was based on the initial clinical findings identifying risk factors for arterial bleeding, is expected to be helpful in rapidly establishing a treatment plan and improving the prognosis for patients with pelvic bone fractures.
Highlights
Pelvic bone fractures are one of the biggest challenges faced by trauma surgeons
Significant group differences were found for the following variables: a systolic blood pressure (SBP) < 90 mmHg, heart rate (HR) > 120 bpm, body temperature (BT) < 36 °C, serum lactate level > 3.4 mmol/L, and base deficit < − 6 mmol/L
We investigated the associations between pelvic arterial bleeding and the initial laboratory and clinical findings, including the pelvic bone fracture pattern on AP pelvic radiography, performed during an initial visit to the emergency room (ER) after trauma
Summary
Pelvic bone fractures are one of the biggest challenges faced by trauma surgeons. Especially, the presence of bleeding and hemodynamic instability features is associated with high morbidity and mortality in patients with pelvic fractures. The aim of this study was to develop a nomogram to predict arterial bleeding in patients with pelvic bone fractures after blunt trauma. Pelvic bone fractures can be a significant cause of bleeding and death and are currently among the biggest challenges faced by trauma surgeons [1, 2]. It is difficult to rapidly identify (or distinguish) the origin of bleeding (whether it is of venous, bone, or arterial origin) following a pelvic fracture. Recent studies have reported on the predictive factors of arterial bleeding in trauma patients with pelvic bone fractures [3, 6,7,8,9], the usefulness of these predictors in a clinical setting remains unclear. There is a need for a simple and convenient scoring system to predict arterial bleeding in patients with pelvic bone fracture in the initial post-injury period
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
