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

Background 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...

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Bibliographic Details
Published in:European journal of trauma and emergency surgery (Munich : 2007) 2021-04, Vol.47 (2), p.493-498
Main Authors: Schweigkofler, Uwe, Wohlrath, Bernd, Trentzsch, Heiko, Horas, Konstantin, Hoffmann, Reinhard, Wincheringer, Dennis
Format: Article
Language:English
Subjects:
Ambulance services
Critical Care Medicine
Emergency medical care
Emergency Medicine
Fractures
Injuries
Intensive
Medical prognosis
Medicine
Medicine & Public Health
Original Article
Orthopedic apparatus
Orthopedics
Pelvis
Sports Medicine
Surgery
Surgical Orthopedics
Traumatic Surgery
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Summary:Background 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. Methods 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. Results 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 72 h. There was no significant difference in hospital mortality (20% vs. 13.3%). Conclusion 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.
ISSN:1863-9933
1863-9941
DOI:10.1007/s00068-019-01239-6