Unifying Concepts

Criteria for Diagnostic of Fat Embolism Syndrome (FES)

Fat embolism syndrome, a condition characterized by hypoxia, bilateral pulmonary infiltrates, and mental status change.

Gurd’s and Wilson’s criteria
Major criteria

  • Axillary or subconjunctival petechiae
  • Hypoxaemia (PaO2 <60 mm Hg; FIO2 = 0.4)
  • Central nervous system depression disproportionate to hypoxaemia
  • Pulmonary oedema

Minor criteria

  • Tachycardia >110 bpm
  • Pyrexia >38.5 °C
  • Emboli present in the retina on fundoscopy
  • Fat present in urine
  • A sudden inexplicable drop in haematocrit or platelet values
  • Increasing ESR
  • Fat globules present in the sputum

For the diagnosis of fat embolism syndrome, at least one major and four minor criteria must be present.

Schonfeld’s criteria

  • Petechiae (5 points)
  • X-ray chest diffuse infiltrates (4 points)
  • Hypoxemia (3 points)
  • Fever (1 point)
  • Tachycardia (1 point)
  • Tachypnea (1 point)
  • Confusion (1 point)

Score > 5 diagnosis FES



  1. Akhtar S. Fat embolism. Anesthesiol Clin. 2009 Sep;27(3):533-50. [Medline]
  2. Glazer JL, Onion DK. Fat embolism syndrome in a surgical patient. J Am Board Fam Pract. 2001 Jul-Aug;14(4):310-3. [Medline]
  3. Gurd AR, Wilson RI. The fat embolism syndrome. J Bone Joint Surg Br. 1974 Aug;56B(3):408-16. [Medline]


Created Oct 14, 2014.

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