Effect of Early Pelvic Binder Use in the Emergency Management of Suspected Pelvic Trauma: A Retrospective Cohort Study.

Sheng-Der Hsu,De-Chuan Chan,Sheng-Hao Wang,Yu-Ching Chou,Cheng-Jueng Chen

doi:10.3390/ijerph14101217

Abstract

Background: We aimed to evaluate the effect of early pelvic binder use in the emergency management of suspected pelvic trauma, compared with the conventional stepwise approach. Methods: We enrolled trauma patients with initial stabilization using a pelvic binder when suspecting pelvic injury. The inclusion criteria were traumatic injury requiring a trauma team and at least one of the following: a loss of consciousness or a Glasgow coma score (GCS) of <13; systolic blood pressure of <90 mmHg; falling from ≥6 m; injury to multiple vital organs; and suspected pelvic injury. Various parameters, including gender, age, mechanism of injury, GCS, mortality, hospital stay, initial vital signs, revised trauma score, injury severity score, and outcome, were assessed and compared with historical controls. Results: A total of 204 patients with high-energy multiple-trauma from a single level I trauma center in North Taiwan were enrolled in the study from August 2013 to July 2014. The two group baseline patient characteristics were all collected and compared. The trauma patients with suspected pelvic fractures initially stabilized with a pelvic binder had shorter hospital and intensive care unit (ICU) stays. The study group achieved statistically significantly improved survival and lower mean blood transfusion volume and mortality rate, although they were more severe in the trauma score. Conclusions: We recommend prompt pelvic binder use for suspected pelvic injury before definitive imaging is available, as a cervical spine collar is used to protect the cervical spine from further injury prior to definitive identification and characterization of an injury.

Highlights

Patients with severe pelvic fractures present many challenges to the trauma team, a correct diagnosis of pelvic injury is crucial since pelvic injuries often occur in conjunction with other life-threatening injuries
From August 2013 to July 2014, patients who met the criteria were enrolled and received early pelvic binder use for the emergency management of suspected pelvic trauma as they arrived at our emergency department (ED)
Patients with trauma injury and any type of pelvic fractures confirmed by radiological imaging (such as pelvic X-ray or computed tomography (CT) scan) in accordance with a new protocol emphasizing the early use of a pelvic binder performed by the ED physicians for trauma patients with suspected pelvic injury were included (Figure 1)

Summary

Introduction

Patients with severe pelvic fractures present many challenges to the trauma team, a correct diagnosis of pelvic injury is crucial since pelvic injuries often occur in conjunction with other life-threatening injuries. Among patients with multiple injuries because of blunt trauma, 5–16% sustain injuries to the pelvic ring, resulting in a mortality rate of 11–54% that is primarily due to hemorrhagic shock [1,2,3]. It is important to control associated hemorrhage when managing pelvic fractures. The initial management of a pelvic fracture is based on the Advanced Trauma Life. We aimed to evaluate the effect of early pelvic binder use in the emergency management of suspected pelvic trauma, compared with the conventional stepwise approach

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Methods

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Conclusion