title: Factors associated with pelvic fracture-related arterial bleeding during trauma resuscitation: a prospective clinical study.
abstract: OBJECTIVE
  To determine predictors of pelvic fracture-related arterial bleeding (PFRAB) from the information available in the Emergency Department (ED).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Single level-1 Trauma Center.
  
  
  METHODS
  In a 3-year period ending in December 2008, consecutive high-energy pelvic fracture patients older than 18 years were included. Patients who arrived >4 hours after injury or dead on arrival were excluded. Patient management followed advanced trauma life support and institutional guidelines. Collected data included patient demographics, mechanism of injury, vital signs, acid-base status, fluid resuscitation, trauma scores, fracture patterns, procedures, and outcomes. Potential predictors were identified using standard statistical tests: Univariate analysis, Pearson correlation (r), receiver operator characteristic, and decision tree analysis.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  PFRAB was determined based on angiography or computed tomography angiogram or laparotomy findings.
  
  
  RESULTS
  Of the 143 study patients, 15 (10%) had PFRAB. They were significantly older, more severely injured, more hypotensive, more acidotic, more likely to require transfusions in the ED, and had higher mortality rate than non-PFRAB patients. No single variable proved to be a strong predictor but some had a significant correlation with PFRAB. Useful predictors identified were worst base deficit (BD), receiver operator characteristic (0.77, cutoff: 6 mmol/L, r = 0.37), difference between any 2 measures of BD within 4 hours (ΔBD) >2 mmol/L, transfusion in ED (yes/no), and worst systolic blood pressure <104 mm Hg. Demographics, injury mechanism, fracture pattern, temperature, and pH had poor predictive value.
  
  
  CONCLUSIONS
  BD <6 mmol/L, ΔBD >2 mmol/L, systolic blood pressure <104 mm Hg, and the need for transfusion in ED are independent predictors of PFRAB in the ED. These predictors can be valuable to triage blunt trauma victims for pelvic hemorrhage control with angiography.
  
  
  METHODS
  Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Toth
authors.forename: Kate L
authors.initials: KL
authors.lastname: King
authors.forename: Benjamin
authors.initials: B
authors.lastname: McGrath
authors.forename: Zsolt J
authors.initials: ZJ
authors.lastname: Balogh
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000293:injuries; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006470:Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D011446:Prospective Studies; D011859:Radiography; D012151:Resuscitation / Q000379:methods*; D012307:Risk Factors; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D055815:Young Adult