To bind or not to bind: The pelvic2bind cross-sectional survey study

Pelvic injuries mainly arise from high-energy traumas. The preclinical application of pelvic binders is advocated for suspected pelvic fractures with hemorrhage. In vitro cadaveric studies do not provide proof of principle despite their widespread use. This study evaluates clinical experience and physician perceptions regarding the use of pelvic binders in pelvic trauma. A total of 271 physicians regularly treating polytraumatized patients were surveyed using a 22-item multiple-choice questionnaire. Participants were recruited at trauma surgery conferences in 2019 and 2020 and via the mailing list of the German Society of Trauma Surgery. Data included respondents' professional background and experience in the treatment of pelvic trauma. Most participants were experienced trauma surgeons, with 76.6% holding a consultant-level position and 68.6% having over 10 years of trauma experience. Pelvic binders were the most commonly used external stabilization device (90.4%), although only 48.9% believed they led to hemodynamic improvement in the majority of patients. Furthermore, 95% estimated that ≤ 50% of patients with pelvic fractures actually bled due to the fracture, and 88.5% reported that fewer than half of patients arriving with a binder had confirmed fractures. Despite this, 95.1% of respondents still felt pelvic binders were more effective than harmful. While pelvic binders remain widely accepted by clinicians, the survey findings indicate a disconnect between their routine use and the low observed rate of fracture-associated bleeding or confirmed pelvic injuries. These results suggest the need for more selective, evidence-based application of pelvic binders in the prehospital setting.