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Sng M, Gentle J, Asadollahi S. Bleeding Risk Associated With Hemodynamically Stable Low-Energy Pelvic Fracture. Geriatr Orthop Surg Rehabil 2020; 11:2151459320911868. [PMID: 32284903 PMCID: PMC7133069 DOI: 10.1177/2151459320911868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 11/23/2019] [Accepted: 12/08/2019] [Indexed: 12/23/2022] Open
Abstract
Introduction: Life-threatening hemorrhage associated with low-energy pelvic fracture has been described in single cases in the literature. However, there is limited evidence available on the bleeding risk associated with hemodynamically stable osteoporotic pelvic fractures. The objective of this study was to estimate the bleeding risk associated with low-energy osteoporotic pelvic fractures in the elderly population. Materials and Methods: A retrospective review of patients aged > 65 years old with pelvic fractures admitted between 2015 and 2018 was performed. Eighty-two patients were identified: 12 males and 70 females with a median age of 86 years. The median Charlson comorbidity index was 6 (interquartile range = 5-7). Eighty-one fractures were classified as lateral compression I or Tile A2, and 1 fracture was classified as lateral compression II or Tile B2. Forty patients were on concurrent anticoagulation treatment. In 4 patients on warfarin, this treatment was reversed on admission. Results: The mean hemoglobin (Hb) level on arrival was 12.36 g/dL (±1.67 g/dL). There were significant drops in Hb levels on day 1 (Hb = 11.22 ± 1.86 g/dL, P < .001) and day 4 (Hb = 10.97 ± 1.6 g/dL, P < .001). Nine percent of patients required a blood transfusion. The mean baseline Hb level pre-transfusion was 8.33 g/dL (±1.15). Preexisting anticoagulation treatment did not predispose patients to greater decreases in Hb levels on day 1 (mean difference = 0.16 g/dL, P = .62) or day 4 (mean difference = 0.29 g/dL, P = .48) post-admission. Discussion: An observed mean decrease in Hb level of up to 1.4 g/dL can occur in hemodynamically stable elderly patients with osteoporotic pelvic fractures, reflecting an approximate loss of 1.4 units of packed red blood cells. Conclusion: This degree of decrease in Hb may be clinically significant in geriatric patients with chronic anemia and a history of cardiovascular disease.
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Affiliation(s)
- Marcus Sng
- Department of Orthopaedic Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Juliette Gentle
- Department of Orthopaedic Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Saeed Asadollahi
- Department of Orthopaedic Surgery, Northern Health, Melbourne, Victoria, Australia
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Abstract
Pelvic ring fractures are rare injuries in the elderly though the incidence is increasing due to the increasing age of the population. Main goal of treatment is the quickest possible re-mobilization to prevent side-effects of immobilization such as osteopenia, pulmonary infections or thromboembolic events. Isolated anterior pelvic ring fractures are stable injuries and therefore they usually can be treated conservatively, while pelvic ring injuries with involvement of the posterior ring are considered unstable and should undergo surgical stabilization if the patient’s condition allows for it. Conservative treatment includes adequate analgesia, guided mobilization with partial weight bearing if possible and osteoanabolic medication. The appropriate surgical procedure should be discussed in an interdisciplinary round considering patient’s pre-injury condition, anaesthetic and surgical risks.
Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180062
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Affiliation(s)
- Markus A Küper
- BG Trauma Center, Department for Traumatology and Reconstructive Surgery, Eberhard Karls University, Tübingen, Germany
| | - Alexander Trulson
- BG Trauma Center, Department for Traumatology and Reconstructive Surgery, Eberhard Karls University, Tübingen, Germany
| | - Fabian M Stuby
- BG Trauma Center, Department for Traumatology, Orthopedics and Surgery, Murnau am Staffelsee, Germany
| | - Ulrich Stöckle
- BG Trauma Center, Department for Traumatology and Reconstructive Surgery, Eberhard Karls University, Tübingen, Germany
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Wang H, Robinson RD, Moore B, Kirk AJ, Phillips JL, Umejiego J, Chukwuma J, Miller T, Hassani D, Zenarosa NR. Predictors of early versus late mortality in pelvic trauma patients. Scand J Trauma Resusc Emerg Med 2016; 24:27. [PMID: 26964737 PMCID: PMC4785731 DOI: 10.1186/s13049-016-0220-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/04/2016] [Indexed: 11/22/2022] Open
Abstract
Background Risks of predicting time-related in-hospital mortality varies in pelvic trauma patients. We aim to identify potential independent risks predictive of time-related (early versus late) mortality among pelvic trauma patients. Methods Local trauma registry data from 2004 through 2013 were reviewed. Mortality causes and timing of death were investigated. Multivariate logistic regression identified independent risks predictive of early versus late mortality in pelvic trauma patients while adjusting for patient demographics (age, sex, race), clinical variables (initial vital signs, mental status, injury severity, associated injuries, comorbidities), and hospital outcomes (surgical interventions, crystalloid resuscitations, blood transfusions). Results We retrospectively collected data on 1566 pelvic trauma patients with a mortality rate of 9.96 % (156/1566). Approximately 74 % of patients died from massive hemorrhage within the first 24 h of hospitalization (early mortality). Revised trauma score (RTS), injury severity score (ISS), initial hemoglobin, direct transfer to operating room, and blood transfusion administration in the Emergency Department were considered independent risk factors predictive of early mortality. Age, ISS, and Glasgow Coma Scale (GCS) were deemed risk factors predictive of death after 24 h (late mortality). Discussion Given the fact of a substantial number of patients died within the first 24 h of hospital arrival, it is reasonable to consider the first 24 h of hospitalization as the appropriate window within which early mortality may be expected to occur in pelvic trauma patients. The risk factors associated with massive hemorrhage were strong predictors of early mortality, whereas late mortality predictors were more closely linked with comorbidities or in-hospital complications. Conclusions While risk factors predictive of early versus late mortality vary, ISS seems to predict both early and late mortality accurately in pelvic trauma patients.
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Affiliation(s)
- Hao Wang
- Emergency Department, JPS Health Network, 1575 S. Main St, Fort Worth, TX, 76104, USA.
| | - Richard D Robinson
- Emergency Department, JPS Health Network, 1575 S. Main St, Fort Worth, TX, 76104, USA
| | - Billy Moore
- Research Institute, JPS Health Network, 1500 S. Main St, Fort Worth, TX, 76104, USA
| | - Alexander J Kirk
- Emergency Department, JPS Health Network, 1575 S. Main St, Fort Worth, TX, 76104, USA
| | | | - Johnbosco Umejiego
- Emergency Department, JPS Health Network, 1575 S. Main St, Fort Worth, TX, 76104, USA
| | - Joseph Chukwuma
- Emergency Department, JPS Health Network, 1575 S. Main St, Fort Worth, TX, 76104, USA
| | - Tyler Miller
- Emergency Department, JPS Health Network, 1575 S. Main St, Fort Worth, TX, 76104, USA
| | - Donna Hassani
- University of South Florida, Morsani College of Medicine, 12901 Bruce B. Downs Blvd., MDC061, Tampa, FL, 33612-4799, USA
| | - Nestor R Zenarosa
- Research Institute, JPS Health Network, 1500 S. Main St, Fort Worth, TX, 76104, USA
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