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Are Pelvic Binders an Effective Prehospital Intervention?
Abdulai Bangura1, Cynthia E Burke1, Blessing Enobun1
1R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Insights
Prehospital use of pelvic circumferential compression devices (PCCDs) by emergency medical services (EMS) varies widely. This study found no significant improvement in patient outcomes with prehospital PCCD application, suggesting benefits may be limited to severe cases.
Area of Science:
- Trauma care
- Emergency medical services
- Orthopedic emergencies
Background:
- Prehospital application of pelvic circumferential compression devices (PCCDs) by emergency medical services (EMS) has seen slow and inconsistent adoption across the United States.
- There is a need to understand the current frequency of PCCD use in the prehospital setting and its impact on early patient outcomes.
Purpose of the Study:
- To determine the frequency of prehospital PCCD use by EMS providers.
- To investigate factors associated with prehospital PCCD application.
- To evaluate the association between prehospital PCCD use and early hemorrhagic shock outcomes.
Main Methods:
- A single-center retrospective cohort study was conducted involving 162 patients with unstable pelvic ring injuries transported by EMS between 2011 and 2020.
- Data on prehospital treatment, including PCCD application, were extracted from EMS medical records.
- Outcomes assessed included the proportion of patients receiving a prehospital PCCD, factors influencing its use, changes in vital signs, blood transfusion requirements, and mortality.
Main Results:
- Only 32.2% of patients received a prehospital PCCD, with significant variation based on patient characteristics, geographic location, and EMS provider level.
- Helicopter paramedics applied PCCDs more frequently (46%) compared to local EMS (≤5%).
- No significant improvements in clinical outcomes, such as vital signs, 24-hour blood transfusions, or mortality, were associated with prehospital PCCD use.
Conclusions:
- Significant practice variation exists in the prehospital application of PCCDs among EMS providers.
- This study did not find evidence of clinical benefits associated with the routine prehospital use of PCCDs.
- Potential benefits of prehospital PCCDs may be confined to patients with the most severe pelvic fractures and hemodynamic instability.
Objective:
Widespread adoption of prehospital pelvic circumferential compression devices (PCCDs) by emergency medical services (EMS) systems has been slow and variable across the United States. We sought to determine the frequency of prehospital PCCD use by EMS providers. Secondarily, we hypothesized that prehospital PCCD use would improve early hemorrhagic shock outcomes.
Methods:
We conducted a single-center retrospective cohort study of 162 unstable pelvic ring injuries transported directly to our center by EMS from 2011 to 2020. Included patients received a PCCD during their resuscitation (prehospital or emergency department). Prehospital treatment details were obtained from the EMS medical record. The primary outcome was the proportion of patients who received a PCCD by EMS before hospital arrival. Secondarily, we explored factors associated with receiving a prehospital PCCD, and its association with changes in vital signs, blood transfusion, and mortality.
Results:
EMS providers documented suspicion of a pelvic ring fracture in 85 (52.8%) patients and 52 patients in the cohort (32.2%) received a prehospital PCCD. Wide variation in prehospital PCCD use was observed based on patient characteristics, geographic location, and EMS provider level. Helicopter flight paramedics applied a prehospital PCCD in 46% of the patients they transported (38/83); in contrast, the EMS organizations geographically closest to our hospital applied a PCCD in ≤5% of cases (2/47). Other predictors associated with receiving a prehospital PCCD included lower body mass index (p = 0.005), longer prehospital duration (p = 0.001) and lower Injury Severity Score (p < 0.05). We were unable to identify any improvements in clinical outcomes associated with prehospital PCCD, including early vital signs, number of blood transfusions within 24 hours, or mortality during admission (p > 0.05).
Conclusion:
Our results demonstrate wide practice variation in the application of prehospital PCCDs. Although disparate PCCD application across the state is likely explained by differences across EMS organizations and provider levels, our study was unable to identify any clinical benefits to the prehospital use of PCCDs. It is possible that the benefits of a prehospital PCCD can only be observed in the most displaced fracture patterns with the greatest early hemodynamic instability.
