Don't ignore the patient with a "fragility fracture"! Risk factors for bleeding from stable pelvic fractures.

BACKGROUND

Stable pelvic fractures are common in elderly patients. Significant bleeding (SigBleed)- requiring transfusion or angioembolization- is reported in 9-15 ​%. Bleeding risk factors are poorly defined. We hypothesized that SigBleed is related to antithrombotic therapy and sarcopenia.

METHODS

Level I trauma center retrospective review (2015-2021). Primary outcome was SigBleed. Sarcopenia measured by psoas:lumbar vertebral body index (PLVI).

RESULTS

141 patients (70% female; mean age 80; 52% on antithrombotics) had mean Injury Severity Score (ISS) 8.8, mean PLVI 0.50. 24% had adverse hematoma characteristics. 22% had SigBleed: 28 (20%) received transfusion and 15 (11%) angioembolization. Adverse hematoma characteristics and ISS were independent predictors of SigBleed; PLVI (OR 0.01 [0.00002, 0.88], p ​= ​0.065) and antithrombotics were not significant.

CONCLUSIONS

Older patients with stable pelvic fractures have a relatively high rate of clinically-important bleeding. Awareness of the issue and identification of risk factors is important. The relationship between sarcopenia and bleeding requires further study.