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Predictive Factors for the Application of Pelvic Binders in the Prehospital Setting
Peter Nguyen1, Courtney Pokrzywa1, Juan Figueroa1
1Department of Surgery, Division of Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
Insights
Early application of pelvic binders in trauma patients can prevent hemorrhage. A new model uses prehospital criteria like blunt injury and hemodynamic instability to guide binder use, improving outcomes for pelvic fractures.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Clinical Prediction Models
Background:
- Early pelvic binder placement is crucial for stabilizing pelvic fractures and controlling hemorrhage.
- Current triage for pelvic binder application faces challenges despite known risk factors.
Purpose of the Study:
- To develop a prediction model using exclusively prehospital criteria to aid in the decision to apply a pelvic binder.
- To improve the timely and accurate triage of patients requiring pelvic binders in the prehospital setting.
Main Methods:
- Utilized a trauma registry from an urban Level I trauma center (2013-2017).
- Identified predictors of pelvic fracture using univariate and multivariate analyses on prehospital data.
- Randomly assigned patients into training (70%) and validation (30%) groups.
Main Results:
- Analysis of 8,480 (training) and 3,676 (validation) trauma patients.
- Significant predictors for pelvic fracture included female sex, hemodynamic instability (SBP < 90 mmHg), blunt injury, specific mechanisms (MVC, motorcycle collision, pedestrian, crush), impact location, and non-front seat position.
- Multivariate models confirmed that two or more risk factors significantly correlate with pelvic fracture presence.
Conclusions:
- Establishing prehospital criteria for empiric pelvic binder use in blunt trauma patients with hemodynamic instability, specific collision impacts, and non-front seat positions can enhance outcomes.
- This predictive model aims to optimize prehospital management of potential pelvic fractures.
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.
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