Prehospital use of pelvic circumferential compression devices in a physician-based emergency medical service: A 6-year retrospective cohort study

Tobias Zingg,Patrick Taffé,Roland Albrecht,Pierre-Nicolas Carron,Vincent Darioli,Romain Piaget-Rossel,Julie Steppacher,Olivier Borens,Mathieu Pasquier,Fabrice Dami,Ludovic Maudet

doi:10.1038/s41598-020-62027-6

Abstract

Fractures of the pelvic ring are a potential source of significant bleeding. Pelvic circumferential compression devices (PCCDs) can reduce and immobilize unstable fractures, but their hemostatic effect is unproven. Our aim was to assess the current practice of prehospital PCCD application and to identify factors available in the field predictive of significant pelvic ring injuries. All interventions (n = 13,435) in the Lausanne University Hospital Emergency Medical Service (EMS) were screened for PCCD placements from January 2008 to November 2014. Significant pelvic ring injuries (Tile types B or C) were considered as potentially benefitting from a PCCD. Data were extracted from the local prehospital registry. During the study period, 2366 trauma missions were performed. A PCCD was applied to 552/2366 (23%) patients. Significant pelvic ring injuries were present in 105/2366 (4.4%). Factors associated with the presence of significant pelvic ring injury were increased respiratory rate (OR 1.04), prolonged capillary refill time (OR 2.11), increased shock index (OR 3.91), pedestrians hit by a vehicle (OR 2.19), and presenting with falls from more than 2 m (OR 1.91). Among patients with a significant pelvic ring injury, a PCCD was placed in 79 (75%) and omitted in 26 (25%). One sixth of patients with a PCCD had a final diagnosis of significant pelvic ring injury. Further studies are needed to better understand which patient-, or accident-related factors are associated with prehospital PCCD omission among patients with significant pelvic ring injury.

Highlights

Trauma associated with pelvic fractures carries a high morbidity and mortality[1,2]
We considered using a Pelvic circumferential compression devices (PCCDs) when a Tile type B or C fracture was present and not using a PCCD in the absence of these fracture types on final diagnosis as optimal performance
Out of the 552 patients on which a PCCD was applied in the field, 79 (14%) had a significant pelvic ring injury

Summary

Introduction

Trauma associated with pelvic fractures carries a high morbidity and mortality[1,2]. Disruption of the pelvic ring acts as a marker for the high amount of kinetic energy absorbed by the body at the time of impact but may cause significant blood loss into the retroperitoneal space from fractured bone surfaces, disruption of the pelvic venous plexus, and/or torn branches of the internal iliac arteries[3,4]. PCCDs may be used in the prehospital setting with the aim of limiting blood loss from pelvic ring injuries as early as possible[19,20]. This practice is widely www.nature.com/scientificreports accepted and recommended[21,22,23,24], specific data on prehospital PCCD application have not been available until recently[13,25,26], and no consensus exists regarding the indications for prehospital PCCD application. Secondary aims were to identify prehospital predictors of significant pelvic ring injury and those associated with the application or omission of PCCDs among these patients

Objectives

Methods

Results

Conclusion