Application Of Pelvic Binder Research Articles

Prehospital Antibiotic Administration for Suspected Open Fractures: Joint COT/OTA/ACEP/NAEMSP/NAEMT Position Statement

One of the primary concerns associated with open fractures is the development of a fracture-related infection (FRI). To minimize the risk of developing an FRI and subsequent morbidity, prophylactic antibiotics should be administered to patients with open fractures as soon as possible. While the antibiotic recommendations for severe open fractures are somewhat debatable, the use of a cephalosporin remains a mainstay of prophylactic treatment. Though administration of prehospital antibiotics does represent an expansion of EMS responsibilities, there have been several other treatment expansions in the prehospital setting, such as the administration of tranexamic acid and the application of pelvic binders. The administration of antibiotics, specifically cefazolin, is inexpensive, technically simple, and does not require special storage. The following recommendations are supported by and represent consensus of the COT, OTA, ACEP, NAEMSP and NAEMT with regards to prehospital antibiotic prophylaxis for suspected fractures: In a responsive patient with no history of penicillin or cephalosporin allergy, the administration by EMS of a 1st generation cephalosporin should be performed after the management of life threats. This intervention should not delay transport. In an obtunded patient, the administration by EMS of a 1st generation cephalosporin should be performed after the management of life-threats. This intervention should not delay transport. In a responsive patient with a documented penicillin allergy, the administration by EMS of a 1st generation cephalosporin should be performed with close monitoring after the management of life-threats. This intervention should not delay transport.

From tradition to innovation: a comparison of the traditional 4-step approach versus a blended learning modification for technical skills teaching

BackgroundThis experimental study was performed to evaluate the role of blended learning for technical skill teaching on the European Trauma Course (ETC). While online modules are extensively used for theoretical teaching, their role in skills training remains less well explored. The ETC currently relies on the established 4-step technique for teaching technical skills. However, the required large cohort of skilled instructors and the time intensity prove increasingly challenging in a current climate of staff shortages and funding constraints. This study assesses if blended learning, combining pre-course online elements with face-to-face training matches the effectiveness of the traditional 4-step approach whilst being more time-efficient.MethodsIn a randomised, multi-centre trial, the conventional face-to-face 4-step technique for teaching a skill of medium complexity, the application of a pelvic binder, was compared with an innovative blended approach. It was hypothesised that the blended approach was non-inferior for skill performance measured after the teaching session and after two days (skill retention) with the time needed for teaching and student/teacher satisfaction as secondary outcomes.ResultsNinety participants, divided into 44 traditional and 46 blended method students, were analysed. Independent-samples t-test showed no significant difference in performance scores and non-inferiority of the blended approach with a half of one standard deviation margin. A statistically significant difference in mean retention scores favored the blended approach. A Mann–Whitney U Test revealed no significant difference in candidate satisfaction levels but a statistically significant difference in instructors' satisfaction levels in favour of the blended approach. Analysis with Welch' t-test demonstrated that the face-to-face teaching time needed for the blended approach was significantly shorter (by 6 min).ConclusionsThe integration of a blended approach with the 4-step technique for teaching pelvic binder application in the ETC streamlined teaching without compromising skill acquisition quality. This innovative approach addresses traditional limitations and shows promise in adapting medical education to modern learning and teaching demands. We suggest that blended learning could also be applied for other skills taught on life support courses.Trial registration: University of Dundee (Schools of Medicine and Life sciences Research Ethics Committee, REC number 22/59, 28th June 2022).

Predictive Factors for the Application of Pelvic Binders in the Prehospital Setting

Objectives Early pelvic binder placement in the field stabilizes pelvic fractures and tamponades potential hemorrhage within the pelvis. Despite known risk factors for pelvic fracture, it remains challenging to quickly triage and correctly apply a pelvic binder. We aim to develop a prediction model that exclusively uses prehospital criteria to inform the decision to place a pelvic binder. Methods The trauma registry was used to identify all trauma patients admitted to an urban Level I trauma center between January 2013 and December 2017. Variables collected included patient demographics, mechanism of injury, prehospital vital signs, and the presence of a pelvic fracture. Participants were randomly assigned to a training group (70%) or a validation group (30%). Univariate analyses were used to identify significant predictors for use in multivariate predictive models. Results A total of 8,480 (65% male; median age 49; median ISS 9) and 3,676 (65% male; median age 48; median ISS 9) trauma patients were randomly assigned to the training and validation groups, respectively. Univariate analysis showed significant likelihood of pelvic fracture associated with female sex, hemodynamic instability (initial systolic blood pressure < 90 mmHg), blunt injury type, specific mechanisms of injury (motor vehicle collision, motorcycle collision, pedestrian struck by motor vehicle, crushing injury, and riding an animal), impact location, and position in vehicle. Multivariate models adjusting for blunt type injury, hemodynamic instability, impact location, and position in vehicle showed that presence of two or more of these risk factors is significantly associated with presence of pelvic fracture. Conclusion Establishing select prehospital criteria for the empiric application of pelvic binders for patients in the field with blunt injuries, hemodynamic instability, frontal or side motor vehicle collision impact, and non-front seat passenger may improve outcomes among patients with pelvic fractures.

Trauma Skill Stations to Improve ED Staff Confidence and Engagement

Introduction:Particular skills are critical when participating in trauma response. Engagement and practice with these skills can help build staff confidence, however, ensuring competency across all staff can prove challenging. Establishing a training utilizing skill stations can positively affect staff experience and confidence measures on predetermined dates to capture all team members is a way to ensure confidence in skills vital for patient care in ED settings. Execution of the “skill station” exercises at measured intervals demonstrated improved confidence in trauma skills by ED staff. Exercises with specific skill-oriented practicum offer low-cost, dynamic training opportunities. Improving confidence and competence in critical trauma-related clinical skills directly improves patient outcomes.Method:Six trauma skill stations were created, aimed at specific skill-based practices. These measured skill competencies include arterial line setup, rapid blood infuser use, defibrillator use, chest tube management, pelvic binder application, and tourniquet application. Competency was reached when participants could effectively perform the skills through teach-back technique.Results:Qualitative feedback demonstrated that nurses felt more confident responding to a patient needing trauma interventions in an ED setting. Nursing staff were more engaged with trauma skills in their scope. All participants were able to appropriately and adequately teach-back the skill with 100% accuracy. Improved knowledge retention will be measured in future training sessions.Pre and post-tests could be utilized to demonstrate more dynamic results. This measurement tool will be utilized in the formal training process moving forward to capture baseline and improvement data more objectively.Conclusion:This low-cost and highly efficient method of strengthening novice nurses’ trauma skills competency and confidence can be utilized across various skills and departments. More confident nurses show improved readiness to respond to a patient in need of trauma interventions.

Pelvic Fractures and the Application of Pelvic Binders in Athletic Training

Context With the rise of athletic trainers (ATs) providing care to more nontraditional sports such as skiing, motor sports, rodeo, and X Games, the potential for dealing with traumatic pelvic injuries has increased from the traditional setting. The prehospital care provided by the AT can greatly reduce the potential complications seen in these patients. Application of a pelvic binder should be integrated into the athletic training education curriculum. Objective To provide the presentation of traumatic pelvic fractures, various types of pelvic binders available in the prehospital setting, and integration and teaching of this skill to professional level athletic training students. Description Students should be able to recognize and assess traumatic pelvic injuries. Proper treatment of these injuries is presented with a step-by-step process of how to manage these injuries in the prehospital setting. Equipment needs and how to teach this within the athletic training setting are discussed. Clinical Advantage(s) Integrating the application of the pelvic binder into current athletic training curricula helps provide ATs another tool to use in helping to prevent blood loss, shock, or death in patients with a possible traumatic pelvic fracture. Conclusion(s) Traumatic pelvic fractures are an important critical injury that must be assessed and addressed promptly to avoid hemorrhage and other sequela.

Benefits of early application of pelvic circumferential compression device to reduce bleeding in pelvic fractures

BackgroundTo study of efficacy of early pelvic circumferential compression device using in patients with suspected pelvic trauma, compared with conventional stepwise approach.MethodsTraumatic injury and at least one of the following criteria are required for inclusion: loss of consciousness or a Glasgow coma score (GCS) of less than 13; systolic blood pressure less than 90 mmHg; falling from more than 6 m; injury to several important organs; and a positive pelvic compression test. Patients who satisfied the inclusion criteria for the experimental group were given an early application of a commercial pelvic sling beginning in July 2019. The control group consisted of cases who got the device after clinical or radiological confirmation of a pelvic fracture in the previous year. Gender, age, mechanism of injury, GCS, hospital stay, amount of packed red blood cell transfusion, hematocrit in emergency room, and hematocrit 24 h after application of pelvic binder were all assessed and compared.ResultsThe study had a total of 30 participants, with 15 in each group. The number of packed red blood cell transfusions in the early pelvic binder group (0.80 ± 1.42) is considerably lower than in the control group (2.4 ± 2.32) (P = 0.008), although the hematocrit change is not statistically different between the groups (2.1 VS 0.7) (P = 0.191). The time it took to install a pelvic binder was considerably shorter in the early pelvic binder group (16.40 ± 5.45) than in the control group (40.40 ± 13.64) (P = 0.001). There were no problems associated to soft tissue and skin necrosis in either group of patients.ConclusionsThe use of the PCCD for 24 h prior to clinical and radiographic confirmation has significantly reduced the rate of packed red blood cell transfusion in any pelvic fracture patient without device-related complications.Trial registrationThe study was entered into the Thai Clinical Trials Registry (TCTR20210809007).

In a simulated adult trauma patient, can pelvic binders be applied accurately by paramedics and HEMS paramedics? A pilot observational study.

Background:Pre-hospital treatment of suspected haemorrhagic pelvic fractures includes application of a purpose-made pelvic binder. Recent hospital studies identified poor accuracy of pelvic binder application, but there is little pre-hospital research to date.Methods:A pilot observational study was conducted in an NHS ambulance service to examine the accuracy of landmark identification and pelvic binder application. Paramedics and Helicopter Emergency Medical Service (HEMS) paramedics were recruited via an internal advert. Participants were asked to name and identify the landmarks (greater trochanters) on a simulated patient and apply the Prometheus pelvic splint. Participants read two clinical scenarios and indicated if they would apply a pelvic binder. Descriptive and inferential statistics were used in the analysis of results to compare performance between the two groups.Results:Twenty-six paramedics were recruited. A total of 92.3% (n = 12) paramedics and 100% (n = 13) HEMS paramedics verbalised the correct landmarks. A total of 23.1% (n = 3) paramedics and 61.5% (n = 8) HEMS paramedics identified the correct landmarks on both sides of the pelvis. A total of 15.4% (n = 2) paramedics and 61.5% (n = 8) HEMS paramedics applied the pelvic binder centrally over both greater trochanters. Clinical decision-making to apply a pelvic binder was largely in accordance with a local standard operating procedure.Conclusion:This study supports existing research highlighting cases of inaccurate pelvic binder placement. HEMS paramedics were more accurate than paramedics, but only 39% of all binders placed in the study were applied correctly. Frequent exposure to major trauma and familiarity with pelvic binders may have resulted in greater accuracy among HEMS paramedics. Further education and training around clinical assessment of the pelvis may improve the accuracy of pelvic binder application by all paramedics. This would subsequently improve the quality of patient care and ensure adequate haemorrhage control is maintained.

A review of blunt pelvic injuries at a major trauma centre in South Africa

Background The collective five-year experience with the acute management of pelvic trauma at a busy South African trauma service is reviewed to compare the usefulness and applicability of current grading systems of pelvic trauma and to review the compliance with current guidelines regarding pelvic binder application during the acute phase of resuscitation. Methods A retrospective review was conducted over a 5-year period from December 2012 to December 2017 on all polytrauma patients who presented with a pelvic fracture. Mechanism of injury and presenting physiology and clinical course including pelvic binder application were documented. Pelvic fractures were graded according to the Young- Burgess and Tile systems. Results There was a cohort of 129 patients for analysis. Eighty-one were male and 48 female with a mean age was 33.6 ± 13.1 years. Motor vehicle-related collisions (MVCs) were the main mechanism of injury (50.33%) and pedestrian vehicle collisions (PVCs) were the second most common (37.98%). The most common associated injuries were abdominal injuries (41%), chest injury (37%), femur fractures (21%), tibia fractures (15%) and humerus fracture (14.7%). Thirty patients in this cohort (23%) underwent a laparotomy. They were mainly in the Tile B (70%) and lateral compression (63%) groups. Nine patients underwent pelvic pre-peritoneal packing. Thirty-five (27%) patients were admitted to ICU. Fifteen (12%) patients died. The Young-Burgess classification had a greater accuracy in predicting death than the Tile classification. Forty per cent of deaths occurred in ICU, 33% died secondary to a traumatic brain injury (TBI). Twenty per cent died in casualty and 6.6% in the operating room from ongoing haemorrhage. A pelvic binder was not applied in 66% of patients. In the 34% of patients who had a pelvic binder applied, it was applied post CT scan in 24.8%, in the pre-hospital setting in 7.2%, and on arrival in 2.4% of patients. In 73% of deaths, a binder was not applied, and of those deaths, 54% showed signs of haemodynamic instability. Conclusion It would appear that our application of pelvic binders in patients with acute pelvic trauma is ad hoc. Appropriate selection of patients, who may benefit from a binder and it's timely application, has the potential to improve outcome in these patients.

Military experience in the management of pelvic fractures from OIF/OEF

IntroductionPelvic fractures are a common occurrence in combat trauma. However, the fracture pattern and management within the most recent conflicts, i.e. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF),...

How effective are different models of pelvic binders: results of a study using a Pelvic Emergency Simulator.

The application of pelvic binders in the preclinical and early clinical phase is advisable to avoid or treat C-problems in unstable and potential bleeding pelvic ring fractures, even if the clinical effectivity is not completely proved. The use for pathologies in the posterior pelvic ring is still debatable. We determined if there is a difference in achievable compression in the dorsal pelvic ring depending on position and pelvic binder model. Can this effect be tested with a simplified artificial model? We simulated a Tile type C fracture within the established pelvic emergency trainer and measured in a test series the effectivity of reduction with a non-invasive stabilization technique using 3 different pelvic binders. Any therapeutic effect of a pelvic binder with compression to the posterior pelvic ring requires at first a reduction maneuver. While the compression effect in the symphysis depends only on positioning of the binder, in the posterior pelvic ring, the result varies with the used model. The achievable pressure in the SI joint with a pelvic binder is only 20-25% (33.5-47N) compared to the C-Clamp values (156N). The use of pelvic binders for non-invasive pelvic ring stabilization, even with a posterior pathology, could be proven in a simplified fracture model. A proper fracture reduction and an adequate device positioning influence the effectiveness. The use of an emergency pelvic trainer even for a non-invasive maneuver is advisable.

Retrospective analysis of treatment outcomes in polytrauma patients with multiple long bone fractures of lower extremities

The aim: to conduct retrospective analysis of treatment outcomes in polytrauma patients with multiple long bone fractures of lower extremities.Materials and methods: retrospective study of treatment results in patients hospitalized to the polytrauma department of Kyiv City Clinical Hospital №17 from January 2013 to December 2016.Results: among patients with polytrauma and multiple long bone fractures of lower extremities, males dominated (67.9%) and the main cause of injury was a road accident (73.3%). The most common localizations of injuries were chest trauma (82.4%), traumatic brain injury (74.8%). The severity of injury was 29.2 ± 10.5 points according to the Injury Severity Score (ISS), degree of consciousness disorders was 9.1 ± 3.3 points in conformity with Glasgow Coma Scale (GCS). Patients developed complications, including nosocomial pneumonia (40.5%), acute respiratory distress syndrome (ARDS) (19.1%) and fat embolism syndrome (10.7%), as well as sepsis (28.2%) and multiple organ failure (MOF) (16.0%). Mortality rate was 24.4%.Conclusion: It was found that among patients with polytrauma and multiple long bone fractures of lower extremities males dominated on the basis of gender, the main cause of injury was a road accident. The most common localizations of injuries were chest trauma and traumatic brain injury. Among controversial issues of treatment and diagnostic process are low frequency of pelvic binder application, ultrasound according to focused assessment with sonography for trauma (FAST) protocol and whole body multispiral computed tomography (WBMCT), which should be performed in 100.0% of patients with high-energy trauma at the time of admission to the hospital. In addition, frequency of Early Total Care (ETC) tactics application was too low, and definitive osteosynthesis in some cases was performed unreasonably late, using conservative fixation methods, which is a cause of complications and treatment prolongation in patients with polytrauma.The most common complications were pulmonary: nosocomial pneumonia, ARDS and fat embolism syndrome. Mortality rate was 24.4%.

Application of pelvic binders by student paramedics: an observational cohort study

Background: Pelvic fractures occur in approximately 20% of all multi-system traumas and can lead to loss of life through exsanguination. Advanced Trauma Life Support (ATLS) guidelines advocate application of a pelvic binder, which is most effective when placed at the level of the greater trochanters; however, multiple studies demonstrate a high degree of misplacement. Aims: The aim of the current study was to assess the ability of UK student paramedics to locate the greater trochanters and optimally apply pelvic binders. Methods: A total of 52 student paramedics from UK universities were asked to apply a pelvic binder to a healthy volunteer using a recognised technique. The primary outcome was the location of the pelvic binder compared with an optimally applied device. Findings: n=52 with 17/49 pelvic binders incorrectly located (34%); 18% were too low and 16% were too high. Conclusion: The results demonstrate a high degree of misplacement; this represents both a challenge and an opportunity for UK higher education institutions to review the manner in which pelvic binder application is taught to the next generation of prehospital practitioners.

Is there any benefit in the pre-hospital application of pelvic binders in patients with suspected pelvic injuries?

Massive hemorrhage is a common cause of death in patients sustaining instable pelvic ring fractures. Pelvic binders have been propagated for rapid, non-invasive pelvic ring stabilization and control of severe pelvic hemorrhage. There is a recommendation to applicate a pelvic binder due to the trauma mechanism alone. However, there is little evidence to support this advice. The aim of this study was to evaluate effects of an early pelvic binder application on transfusion requirements and hospital mortality. This was a subgroup analysis of a study investigating clinical examination for pelvic stability. We included 64 patients who showed radiologically proven pelvic ring fracture (Tile type B or C). Study data were complemented by retrospective chart review to assess transfusion requirements. We used descriptive statistical analysis. 37 patients had a pelvic binder applied during prehospital treatment (pb), 27 received no binder (npb). Both showed no statistically significant difference in terms of injury severity or probability of survival. We found a trend towards higher ISS (29.7 vs. 24.4) and a lower probability of survival (RISC-II Prognosis 81% vs. 89%) in the pb group. Risk for massive transfusion according to TASH-Scores (10% vs. 6%), and average number of RPBC transfused (10.5 vs. 7.5) was higher in the pb group, without statistically significance. 20 patients (54%) in the pb group and 15 patients (55%) in the npb group showed a need of RPBC within the first 72h. There was no significant difference in hospital mortality (20% vs. 13.3%). We were unable to identify blood-saving effects with application of a pelvic binder to patients with instable pelvic ring fractures in terms of RPBC requirements. Nevertheless, some salutary effect of prehospital pb application may be assumed. Better studies are needed to elucidate the value of this intervention.

Early detection of severe injuries after major trauma by immediate total-body CT scouts

IntroductionEvaluation of immediate total-body CT (iTBCT) scouts during primary trauma care could be clinically relevant for early detection and treatment of specific major injuries. The aim of this study was to determine the diagnostic usefulness of TBCT scouts in detecting life-threatening chest and pelvic injuries. MethodsAll patients who underwent an iTBCT during their primary trauma assessment in one trauma center between April 2011 and November 2014 were retrospectively included. Two experienced trauma surgeons and two emergency radiologists evaluated iTBCT scouts with structured questionnaires. Inter-observer agreement and diagnostic properties were calculated for endotracheal tube position and identification of pneumo- and/or hemothorax and pelvic fractures. Diagnostic properties of iTBCT scouts for indication for chest tube placement and pelvic binder application were calculated in comparison to decision based on iTBCT. ResultsIn total 220 patients with a median age of 37 years (IQR 26–59) were selected with a median Injury Severity Score of 18 (IQR 9–27). There was moderate to substantial inter-observer agreement and low false positive rates for pneumo- and/or hemothorax and for severe pelvic fractures by iTBCT scouts. For 19.8%–22.5% of the endotracheal intubated patients trauma surgeons stated that repositioning of the tube was indicated. Positive predictive value and sensitivity were respectively 100% (95%CI 52%–100%) and 50% (95%CI 22%–78%) for decisions on chest tube placement by trauma surgeon 1 and 67% (95%CI 13%–98%) and 22% (95%CI 4%–60%) for decisions by trauma surgeon 2. Only in one of 14 patients the pelvic binder was applied after iTBCT acquisition. ConclusionsiTBCT scouts can be useful for early detection of pneumo- and/or hemothorax and severe pelvic fractures. Decision for chest tube placement based on iTBCT scouts alone is not recommended.

The 10 commandments of exsanguinating pelvic fracture management

Background:Unstable pelvic fractures are highly lethal injuries.Objective:The review aims to summarize the landmark management changes in the past two decades.Methods:Structured review based on pertinent published literatures on severe pelvic fracture was performed.Results:Ten key management points were identified.Conclusion:These 10 recommendations help diminish and prevent the mortality. (1) Before the ABCDE management, preparedness, protection, and decision are essential to optimize patient outcome and to conserve resources. (2) Do not rock the pelvis to check stability, avoid logrolling but prophylactic pelvic binder can be life-saving. (3) Computed tomography scanner can be the tunnel to death for hemodynamically unstable patients. (4) Correct application of pelvic binder at the greater trochanter level to achieve the most effective compression. (5) Choose the suitable binder (BEST does not exist, always look for BETTER) to facilitate body examination and therapeutic intervention. (6) Massive transfusion protocol is only a temporizing measure to sustain the circulation for life maintenance. (7) Damage control operation aims to promptly stop the bleeding to restore the physiology by combating the trauma lethal triad to be followed by definitive anatomical repair. (8) Protocol-driven teamwork management expedites the completion of the multi-phase therapy including external pelvic fixation, pre-peritoneal pelvic packing, and angio-embolization, preceded by laparotomy when indicated. (9) Resuscitation endovascular balloon occlusion of aorta can reduce the pelvic bleeding while awaiting hospital transfer or operation theater access. (10) Operation is the definitive therapy for trauma but prevention is the best treatment, comprising primary, secondary, and tertiary levels.

Timely completion of multiple life-saving interventions for traumatic haemorrhagic shock: a retrospective cohort study

BackgroundEarly control of haemorrhage and optimisation of physiology are guiding principles of resuscitation after injury. Improved outcomes have been previously associated with single, timely interventions. The aim of this study was to assess the association between multiple timely life-saving interventions (LSIs) and outcomes of traumatic haemorrhagic shock patients.MethodsA retrospective cohort study was undertaken of injured patients with haemorrhagic shock who presented to Alfered Emergency & Trauma Centre between July 01, 2010 and July 31, 2014. LSIs studied included chest decompression, control of external haemorrhage, pelvic binder application, transfusion of red cells and coagulation products and surgical control of bleeding through angio-embolisation or operative intervention. The primary exposure variable was timely initiation of ≥ 50% of the indicated interventions. The association between the primary exposure variable and outcome of death at hospital discharge was adjusted for potential confounders using multivariable logistic regression analysis. The association between total pre-hospital times and pre-hospital care times (time from ambulance at scene to trauma centre), in-hospital mortality and timely initiation of ≥ 50% of the indicated interventions were assessed.ResultsOf the 168 patients, 54 (32.1%) patients had ≥ 50% of indicated LSI completed within the specified time period. Timely delivery of LSI was independently associated with improved survival to hospital discharge (adjusted odds ratio (OR) for in-hospital death 0.17; 95% confidence interval (CI) 0.03–0.83; p = 0.028). This association was independent of patient age, pre-hospital care time, injury severity score, initial serum lactate levels and coagulopathy. Among patients with pre-hospital time of ≥ 2 h, 2 (3.6%) received timely LSIs. Pre-hospital care times of ≥ 2 h were associated with delayed LSIs and with in-hospital death (unadjusted OR 4.3; 95% CI 1.4–13.0).ConclusionsTimely completion of LSI when indicated was completed in a small proportion of patients and reflects previous research demonstrating delayed processes and errors even in advanced trauma systems. Timely delivery of a high proportion of LSIs was associated with improved outcomes among patients presenting with haemorrhagic shock after injury. Provision of LSIs in the pre-hospital phase of trauma care has the potential to improve outcomes.

Three Dimensional Quality Assessments of Applied Pelvic Binders.

Objective:To assess the quality of applied pelvic binders using three dimensional computer tomography (3D CT).Methods:A local trauma registry was used to identify patients with pelvic fractures after high-energy trauma during 2011-2015. A 3D CT reconstruction was made from the initial trauma computer tomography images to assess the level of application, symmetricity of the binder and achieved fracture reduction. An acceptable application of the pelvic binder was deemed if it was at the trochanteric level, symmetric and minimized residual displacement.Results:We found 73 patients with a pelvic fracture and a pelvic binder on the initial trauma CT-scan. The mean (±SD) age of the patients was 46±17 years and 40% (n=29) were females. The median ISS score was 38 (IQR;29-50), the mean systolic blood pressure on arrival was 106±46 mmHg and the median GCS on arrival was 14 (IQR;7-15). We found that 59% (n=43) of the binders were correctly applied (symmetric at the trochanteric level, symmetrical and with acceptable residual displacement of the fracture). The 30-day mortality was higher in patients with non-correct application 17% (n=5/30) compared to patients with correct application of the pelvic binder 9.3% (n=4/43) however this was not statistically significant (p=0.562). Conclusion:A substantial number of patients had non-correct application of pelvic binders. Future studies using 3D technique are encouraged to further investigate clinical impacts of non-appropriate application of pelvic binders.

55 ‘Mini Sim’ – innovative bite sized simulation teaching in a busy children’s emergency department

Emergency Medicine requires a highly skilled workforce who are passionate about delivering excellent patient care. Shift patterns linked with the ever increasing numbers of patients who attend Emergency Departments puts...

Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study

BackgroundPelvic fractures are severe injuries with frequently associated multi-system trauma and a high mortality rate. The value of the pelvic fracture pattern for predicting transfusion requirements and mortality is not entirely clear. To address hemorrhage from pelvic injuries, the early application of pelvic binders is now recommended and arterial angio-embolization is widely used for controlling arterial bleeding. Our aim was to assess the association of the pelvic fracture pattern according to the Tile classification system with transfusion requirements and mortality rates, and to evaluate the correlation between the use of pelvic binders and arterial angio-embolization and the mortality of patients with pelvic fractures.MethodsSingle-center retrospective cohort study including all consecutive patients with a pelvic fracture from January 2008 to June 2015. All radiological fracture patterns were independently reviewed and grouped according to the Tile classification system. Data on patient demographics, use of pelvic binders and arterial angio-embolization, transfusion requirements and mortality were extracted from the institutional trauma registry and analyzed.ResultsThe present study included 228 patients. Median patient age was 43.5 years and 68.9% were male. The two independent observers identified 105 Tile C (46.1%), 71 Tile B (31.1%) and 52 Tile A (22.8%) fractures, with substantial to almost perfect interobserver agreement (Kappa 0.70-0.83). Tile C fractures were associated with a higher mortality rate (p = 0.001) and higher transfusion requirements (p < 0.0001) than Tile A or B fractures. Arterial angio-embolization for pelvic bleeding (p = 0.05) and prehospital pelvic binder placement (p = 0.5) were not associated with differences in mortality rates.ConclusionsTile C pelvic fractures are associated with higher transfusion requirements and a higher mortality rate than Tile A or B fractures. No association between the use of pelvic binders or arterial angio-embolization and survival was observed in this cohort of patients with pelvic fractures.

Pelvic trauma mortality reduced by integrated trauma care.

A multidisciplinary approach that emphasised improved triage, early pelvic binder application, early administration of blood and blood products, adherence to algorithmic pathways, screening with focused sonography (FAST), early computed tomography scanning with contrast angiography, angio-embolisation and early operative intervention by specialist pelvic surgeons was implemented in the last decade to improve outcomes after pelvic trauma. The manuscript evaluated the effect of this multi-faceted change over a 12-year period. A retrospective cohort study was conducted comparing patients presenting with serious pelvic injury in 2002 to those presenting in 2013. The primary exposure and comparator variables were the year of presentation and the primary outcome variable was mortality at hospital discharge. Potential confounders were evaluated using multivariable logistic regression analysis. There were 1213 patients with a serious pelvic injury (Abbreviated Injury Scale ≥3), increasing from 51 in 2002 to 156 in 2013. Demographics, injury severity and presenting clinical characteristics were similar between the two time periods. There was a statistically significant difference in mortality from 20% in 2002 to 7.7% in 2013 (P = 0.02). The association between the primary exposure variable of being injured in 2013 and mortality remained statistically significant (adjusted odds ratio 0.10; 95% confidence interval: 0.02-0.60) when adjusted for potential clinically important confounders. Multi-faceted interventions directed at the spectrum of trauma resuscitation from pre-hospital care to definitive surgical management were associated with significant reduction in mortality of patients with severe pelvic injury from 2002 to 2013. This demonstrates the effectiveness of an integrated, inclusive trauma system in achieving improved outcomes.