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. 2023;27(1):24-30.
doi: 10.1080/10903127.2021.2015024. Epub 2022 Jan 25.

Are Pelvic Binders an Effective Prehospital Intervention?

Abdulai Bangura  1 , Cynthia E Burke  1 , Blessing Enobun  1 , Nathan N O'Hara  1 , Joshua L Gary  2 , Doug Floccare  3 , Timothy Chizmar  3 , Andrew N Pollak  1 , Gerard P Slobogean  1
Affiliations

Are Pelvic Binders an Effective Prehospital Intervention?

Abdulai Bangura et al. Prehosp Emerg Care. 2023.

Abstract

Objective: Widespread adoption of prehospital pelvic circumferential compression devices (PCCDs) by emergency medical services (EMS) systems has been slow and variable across the United States. We sought to determine the frequency of prehospital PCCD use by EMS providers. Secondarily, we hypothesized that prehospital PCCD use would improve early hemorrhagic shock outcomes.

Methods: We conducted a single-center retrospective cohort study of 162 unstable pelvic ring injuries transported directly to our center by EMS from 2011 to 2020. Included patients received a PCCD during their resuscitation (prehospital or emergency department). Prehospital treatment details were obtained from the EMS medical record. The primary outcome was the proportion of patients who received a PCCD by EMS before hospital arrival. Secondarily, we explored factors associated with receiving a prehospital PCCD, and its association with changes in vital signs, blood transfusion, and mortality.

Results: EMS providers documented suspicion of a pelvic ring fracture in 85 (52.8%) patients and 52 patients in the cohort (32.2%) received a prehospital PCCD. Wide variation in prehospital PCCD use was observed based on patient characteristics, geographic location, and EMS provider level. Helicopter flight paramedics applied a prehospital PCCD in 46% of the patients they transported (38/83); in contrast, the EMS organizations geographically closest to our hospital applied a PCCD in ≤5% of cases (2/47). Other predictors associated with receiving a prehospital PCCD included lower body mass index (p = 0.005), longer prehospital duration (p = 0.001) and lower Injury Severity Score (p < 0.05). We were unable to identify any improvements in clinical outcomes associated with prehospital PCCD, including early vital signs, number of blood transfusions within 24 hours, or mortality during admission (p > 0.05).

Conclusion: Our results demonstrate wide practice variation in the application of prehospital PCCDs. Although disparate PCCD application across the state is likely explained by differences across EMS organizations and provider levels, our study was unable to identify any clinical benefits to the prehospital use of PCCDs. It is possible that the benefits of a prehospital PCCD can only be observed in the most displaced fracture patterns with the greatest early hemodynamic instability.

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Figures

Figure 1.
Figure 1.
Flow diagram of study patients. Qualifying pelvic ring fractures: LC3, APC2–3, CMI, and VS patterns of the Young and Burgess pelvic ring fracture classification system. PCCD: Pelvic Circumferential Compression Device. EMS: Emergency Medical Services
See this image and copyright information in PMC

References

    1. Marmor M, El Naga AN, Barker J, Matz J, Stergiadou S, Miclau T. Management of pelvic ring injury patients with hemodynamic instability. Front Surg. 2020;7:588845. doi:10.3389/fsurg.2020.588845 - DOI - PMC - PubMed
    1. Pap R, McKeown R, Lockwood C, Stephenson M, Simpson P. Pelvic circumferential compression devices for prehospital management of suspected pelvic fractures: a rapid review and evidence summary for quality indicator evaluation. Scand J Trauma Resusc Emerg Med. 2020;28(1):65. doi:10.1186/s13049-020-00762-5 - DOI - PMC - PubMed
    1. Coccolini F, Stahel PF, Montori G, Biffl W, Horer TM, Catena F, Kluger Y, Moore EE, Peitzman AB, Ivatury R, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 2017;12:5. doi:10.1186/s13017-017-0117-6 - DOI - PMC - PubMed
    1. Gardner MJ, Routt ML. The antishock iliosacral screw. J Orthop Trauma. 2010;24(10):86–89. doi:10.1097/BOT.0b013e3181c81d65 - DOI - PubMed
    1. Tachibana T, Yokoi H, Kirita M, Marukawa S, Yoshiya S. Instability of the pelvic ring and injury severity can be predictors of death in patients with pelvic ring fractures: a retrospective study. J Orthop Traumatol. 2009;10:79–82. doi:10.1007/s10195-009-0050-x - DOI - PMC - PubMed

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