title: Scoring system to predict hemorrhage in pelvic ring fracture.
abstract: Risk factors for hemorrhage in patients with pelvic ring fracture have been widely reported. Because there are many risk factors, it is thought that prediction accuracy of hemorrhage in cases of pelvic ring fracture could be improved by using a scoring system.
  
  
  
  We investigated the risk factors for massive hemorrhage (MH) and created a novel predictive score of MH in pelvic ring fractures.
  
  
  
  We retrospectively reviewed patients with pelvic ring fractures (Abbreviated Injury Score≥3 and age≥16 years) from January 2007 to June 2015. We excluded the cases that might have hemorrhage from other sites sufficient to require a blood transfusion. Massive hemorrhage was defined as hemorrhage requiring transfusion of≥6 red cell concentrate units within 24h of admission.
  
  
  
  The MH group included 27 patients and the non-MH group included 71 patients. Lactate level, AO/OTA classification and extravasation of computed tomography (CT) contrast fluid had a significantly higher risk as a result of multivariable analysis. The combined score using these risk factors according to their odds-adjusted ratios was created to predict for MH: lactate level>2.5-5.0 (mmol/L)=1 point,>5.0 (mmol/L)=2 points, partially stable (OA/OTA classification B1/B2/B3)=1 point, unstable (C1/C2/C3)=2 points, pelvic extravasation of contrast on CT=4 points. The AUC of the calculated score was 0.93 (95% CI: 0.89-0.98).
  
  
  
  The combined score using these risk factors according to their odds-adjusted ratios was created to predict MH and was an effective prediction score.
  
  
  
  IV, retrospective study.
authors.affiliation: Emergency & Critical Care Center, Kochi Health Sciences Center, 2125-1, Ike, Kochi, Japan. Electronic address: takao771577157715@yahoo.co.jp.
authors.forename: T
authors.initials: T
authors.lastname: Ohmori
authors.affiliation: Department of Orthopaedic Surgery, Kochi Health Sciences Center, 2125-1, Ike, Kochi, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Emergency & Critical Care Center, Kochi Health Sciences Center, 2125-1, Ike, Kochi, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kitamura
authors.affiliation: Emergency & Critical Care Center, Kochi Health Sciences Center, 2125-1, Ike, Kochi, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Tamura
authors.affiliation: Department of Orthopaedic Surgery, Kochi Health Sciences Center, 2125-1, Ike, Kochi, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tada
authors.affiliation: Department of Orthopaedic Surgery, Kochi Health Sciences Center, 2125-1, Ike, Kochi, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Orthopaedic Surgery, Kochi Health Sciences Center, 2125-1, Ike, Kochi, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Department of Orthopaedic Surgery, Kochi Health Sciences Center, 2125-1, Ike, Kochi, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Numoto
authors.affiliation: Department of Orthopaedic Surgery, Kochi Health Sciences Center, 2125-1, Ike, Kochi, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Tokioka
mesh_terms: D015998:Abbreviated Injury Scale; D000368:Aged; D019540:Area Under Curve; D001803:Blood Transfusion; D016022:Case-Control Studies; D003287:Contrast Media; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000209:etiology; D005260:Female; D050723:Fractures, Bone / Q000145:classification / Q000150:complications*; D006470:Hemorrhage / Q000097:blood / Q000209:etiology* / Q000628:therapy; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D019344:Lactic Acid
keywords: Fractures; Hemorrhage; Pelvis; Prediction