Factors predicting the need for hemorrhage control intervention in patients with blunt pelvic trauma: a retrospective study

Myoung Jun Kim,Seung Hwan Lee,Jae Gil Lee

doi:10.1186/s12893-018-0438-8

Abstract

BackgroundBlunt pelvic injuries are often associated with pelvic fractures and injuries to the rectum and genitourinary tract. Pelvic fractures can lead to life-threatening hemorrhage, which is a common cause of morbidity and mortality in trauma. Thus, early identification of patients with pelvic fractures at risk severe bleeding requiring urgent hemorrhage control is crucial. This study aimed to investigate early factors predicting the need for hemorrhage control in blunt pelvic trauma.MethodsThe medical records of 1760 trauma patients were reviewed retrospectively between January 2013 and June 2018. We enrolled 187 patients with pelvic fracture due to blunt trauma who were older than 15 years. The pelvic fracture pattern was classified according to the Orthopedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen (OTA/AO) classification. A multivariate logistic regression model was used to determine independent predictors of the need for pelvic hemorrhage control intervention.ResultsThe most common pelvic fracture pattern was type A (54.5%), followed by types B (36.9%) and C (8.6%). Of 187 patients, 48 (25.7%) required pelvic hemorrhage control intervention. Hemorrhage control interventions were most frequently performed in patients with type B fractures (54.2%). Multivariate logistic regression analysis revealed that type B (odds ratio [OR] = 4.024, 95% confidence interval [CI] = 1.666–9.720, p = 0.002) and C (OR = 7.077, 95% CI = 1.781–28.129, p = 0.005) fracture patterns, decreased body temperature (OR = 2.275, 95% CI = 0.134–0.567, p < 0.001), and elevated serum lactate level (OR = 1.234, 95% CI = 1.061–1.435, p = 0.006) were factors predicting the need for hemorrhage control intervention in patients with blunt pelvic trauma.ConclusionPatients with type B and C fracture patterns on the OTA/AO classification, hypothermia, or an elevated serum lactate level are at risk for bleeding and require pelvic hemorrhage control intervention.

Highlights

Blunt pelvic injuries are often associated with pelvic fractures and injuries to the rectum and genitourinary tract
There was no significant difference between the hemorrhage control and non-hemorrhage control intervention groups (p = 0.290)
Type B and C fractures according to the Orthopedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen (OTA/AO) classification were revealed as independent factors predicting the need for hemorrhage control intervention in patients with blunt pelvic trauma

Summary

Introduction

Blunt pelvic injuries are often associated with pelvic fractures and injuries to the rectum and genitourinary tract. Early identification of patients with pelvic fractures at risk severe bleeding requiring urgent hemorrhage control is crucial. This study aimed to investigate early factors predicting the need for hemorrhage control in blunt pelvic trauma. Pelvic injuries occur frequently, amounting to almost 9% of all blunt trauma patients [1]. Blunt pelvic injuries from high-energy mechanisms such as a fall from a height or road traffic collision are often associated with pelvic fractures and injuries to the rectum and genitourinary tract [1,2,3,4]. The purpose of this study was to investigate early factors predicting the need for hemorrhage control intervention in patients with blunt pelvic trauma

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