Bramos Athanasios, Velmahos George C, Butt Umar M, Fikry Karim, Smith R Malcolm, Chang Yuchiao
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Arch Surg. 2011 Apr;146(4):407-11. doi: 10.1001/archsurg.2010.277. Epub 2010 Dec 20.
Stable pelvic fractures (SPFs) that do not need operative fixation are only infrequently associated with significant bleeding (SigBleed). Our hypothesis is that simple indicators, easily detectable at the bedside, can alert the clinician about the likelihood of bleeding and the need for closer monitoring or early intervention in patients with SPFs.
Retrospective review of medical records.
Academic level 1 trauma center.
The medical records of patients with SPFs admitted to our academic level 1 trauma center from January 1, 2002, to June 30, 2007, were reviewed. Stable pelvic fractures were defined as fractures not requiring external or internal fixation. SigBleed was defined as the need for blood transfusion and/or intervention for bleeding control within the first 24 hours after admission. The patients were divided into group A, which included patients without SigBleed; group B, which included patients with SigBleed of a nonpelvic cause; and group C, which included patients with SigBleed caused by the SPF. The 3 groups were compared by univariate and multivariate analysis.
Significant bleeding from SPFs.
Of 391 patients with SPFs, 280 (72%) were in group A, 90 (23%) were in group B, and 21 (5%) were in group C. Compared with group A patients, those in group C were older and had a lower hematocrit and systolic blood pressure on admission. They also had longer hospital stays and a higher mortality. The following independent predictors of SigBleed from SPF were identified: hematocrit of 30% or lower (odds ratio [OR], 43.93; 95% confidence interval [CI], 9.78-197.32; P < .001); presence of pelvic hematoma on computed tomographic scan (OR, 39.37; 95% CI, 4.58-338.41; P < .001); and systolic blood pressure of 90 mm Hg or lower (OR, 18.352; 95% CI, 1.98-169.87; P = .01). When all independent predictors were present, 100% of the patients had SigBleed; when all were absent, no one had SigBleed.
The incidence of SigBleed due to SPFs is low (5% in this study) and independently predicted by an admission hematocrit of 30% or lower, the presence of a pelvic hematoma on computed tomographic scan, and systolic blood pressure of 90 mm Hg or lower.
无需手术固定的稳定性骨盆骨折（SPF）很少伴有大量出血（SigBleed）。我们的假设是，一些简单的指标在床边易于检测，可提醒临床医生注意SPF患者出血的可能性以及密切监测或早期干预的必要性。
对病历进行回顾性研究。
一级学术创伤中心。
回顾了2002年1月1日至2007年6月30日期间入住我们一级学术创伤中心的SPF患者的病历。稳定性骨盆骨折定义为不需要外固定或内固定的骨折。SigBleed定义为入院后24小时内需要输血和/或进行出血控制干预。患者分为A组，包括无SigBleed的患者；B组，包括非骨盆原因导致SigBleed的患者；C组，包括由SPF导致SigBleed的患者。通过单因素和多因素分析对三组进行比较。
SPF导致的大量出血。
在391例SPF患者中，280例（72%）在A组，90例（23%）在B组，21例（5%）在C组。与A组患者相比，C组患者年龄更大，入院时血细胞比容和收缩压更低。他们的住院时间也更长，死亡率更高。确定了以下SPF导致SigBleed的独立预测因素：血细胞比容为30%或更低（比值比[OR]，43.93；95%置信区间[CI]，9.78 - 197.32；P <.001）；计算机断层扫描显示存在盆腔血肿（OR，39.37；95% CI，4.58 - 338.41；P <.001）；收缩压为90 mmHg或更低（OR，18.352；95% CI，1.98 - 169.87；P =.01）。当所有独立预测因素都存在时，100%的患者发生SigBleed；当所有因素都不存在时，无人发生SigBleed。
SPF导致SigBleed的发生率较低（本研究中为5%），且可通过入院时血细胞比容为30%或更低、计算机断层扫描显示存在盆腔血肿以及收缩压为90 mmHg或更低独立预测。
