title: Early, reliable, utilitarian predictive factors for fat embolism syndrome in polytrauma patients.
abstract: BACKGROUND
  Fat embolism is one of the apocalyptic pulmonary complications following high energy trauma situations. Since delay in diagnosis may have devastating consequences, early, easily accessible and relatively inexpensive investigations for risk stratification may prove useful, especially in developing nations.
  
  
  METHODS
  This prospective trial included a total of 67 young polytrauma patients, in whom the role of nine easily available, rapidly performable clinical or laboratory investigations (or observations noted at admission) in predicting the later occurrence of fat embolism syndrome were assessed. All the patients also underwent continuous monitoring of oxygen saturation with pulsoximetry.
  
  
  RESULTS
  The correlation between initial serum lactate (within 12 hours of injury) and hypoxia was statistically significant. There was a trend towards correlation with FES(by Gurd's criteria) (P=0.07), Sensitivity of 24-hour monitoring of oxygen saturation in predicting later pulmonary deterioration approached 100%.
  
  
  CONCLUSIONS
  The combination of three factors including polytrauma (with NISS >17), serum lactate >22 mmol/l at admission (within 12 hours of injury) fall in oxygen saturation (SaO2 below 90% in the initial 24 hours) predict the development of post-traumatic pulmonary complications, especially the fat embolism syndrome.
authors.affiliation: Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Nirmal Raj
authors.initials: NR
authors.lastname: Gopinathan
authors.forename: Ramesh K
authors.initials: RK
authors.lastname: Sen
authors.forename: Vibhu K
authors.initials: VK
authors.lastname: Viswanathan
authors.forename: Amit
authors.initials: A
authors.lastname: Aggarwal
authors.forename: H C
authors.initials: HC
authors.lastname: Mallikarjun
authors.forename: Sakthivel R
authors.initials: SR
authors.lastname: Rajaram Manoharan
authors.forename: Radheshyam
authors.initials: R
authors.lastname: Sament
authors.forename: Avinash
authors.initials: A
authors.lastname: Kumar
keywords: Fat embolism syndrome; polytrauma patients; pulsoximetry; serum lactate