Abstract
IntroductionThere is a lack of data on the use and effectiveness of pre-hospital pelvic circumferential compression devices (PCCD) as a temporary intervention for pelvic fracture management; they are thought to decrease pelvic volume and hemorrhage but are not without risks. The purpose of this study is to examine pre-hospital PCCD practices at US Level I trauma centers.MethodsThis was a prospective cross-sectional survey of trauma medical directors at US Level I trauma centers. The aim of this study was to describe patterns of pre-hospital PCCD utilization for pelvic fractures. Responses were compared by region, length in time the center was designated Level I, trauma patient volume, pelvic management guideline followed and blood product guidelines. Data were compared using Fisher’s exact and chi-squared tests.ResultsOf the 158 Level I trauma centers invited, 25% responded. All Level I trauma centers use in-hospital PCCDs, whereas 71% of participant’s paramedic agencies trained on pre-hospital PCCD application. Of those, 44% trained to apply pre-hospital PCCDs to all suspected pelvic fractures. A higher proportion of high-volume centers (77%) than low-volume centers (25%) trained on pre-hospital PCCD placement, p = 0.06. PCCD practices were not dependent on the trauma center’s region, trauma volume, length in time as a Level I trauma center, or pelvic fracture guideline followed.ConclusionsThere is widespread application of in-hospital and pre-hospital PCCD at US Level I trauma centers, however pre-hospital PCCDs are not applied to all suspected pelvic fractures. Future studies should focus on efficacy, safety, and contraindications for pre-hospital PCCDs.
Highlights
There is a lack of data on the use and effectiveness of pre-hospital pelvic circumferential compression devices (PCCD) as a temporary intervention for pelvic fracture management; they are thought to decrease pelvic volume and hemorrhage but are not without risks
The only guideline that states that PCCD can be placed prehospital is the Western Trauma Association (WTA) guideline, but the WTA guideline states that PCCDs are contraindicated for lateral compression fractures, which would likely be unknown during pre-hospital application [2, 8]
Level I trauma centers were identified from the American College of Surgeons (ACS) website and the trauma medical director was identified via telephone or the center’s website
Summary
There is a lack of data on the use and effectiveness of pre-hospital pelvic circumferential compression devices (PCCD) as a temporary intervention for pelvic fracture management; they are thought to decrease pelvic volume and hemorrhage but are not without risks. PCCDs are thought to decrease pelvic volume and limit hemorrhage but they are not without risk for skin damage, internal organ damage, increase in pelvic inlet area, internal rotation, ulceration, and additional fracturing for lateral compression fractures [1, 3, 4, 6,7,8,9]. This study aimed to describe PCCD practices and to explore the relationship between Level I trauma center characteristics and practices via National survey
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