Prehospital Application of Pelvic Binders for Suspected Pelvic Ring Injuries: A Retrospective Cohort Study

Pelvic fractures are linked to morbidity and mortality from major trauma. The use of pelvic binders in the prehospital setting is recommended for initial stabilization, however indications for application vary. The primary objective of this study was to determine the proportion of patients with image confirmed pelvic fracture in which paramedics applied a pelvic binder. Additionally, patient characteristics were explored to identify associations with unstable pelvic fractures.

This was an observational retrospective cohort study from a single trauma center between January 2017 and December 2022. Patients were included if >16 years of age, transported from scene, and had a confirmed pelvic fracture on imaging. A manual review of electronic medical records and ambulance call records was performed by two reviewers. Continuous variables were summarized as means and standard deviations or medians and interquartile ranges. Categorical variables were summarized as counts and percentages. Multivariable logistic regression explored the association between predetermined prehospital predictors and unstable pelvic fracture. The results of the regression model are presented as odds ratios (OR) and 95% confidence intervals (CI).

In total, 429 patients met initial criteria; 95 were excluded for no records and 15 for no imaging, resulting in a final cohort of 319 patients. The median age was 42 (27-60) years, 61.1% were male, and 72.1% suffered blunt trauma. There were 86 (27.0%) fractures classified as unstable. Overall, 30 (9.4%) patients, 17% (14/86) with unstable fractures had a prehospital pelvic binder applied. Pain on exam and lower systolic blood pressure, and lower GCS score in the prehospital setting were all associated with increased odds of pelvic instability.

Nine percent of all patients, and only 17% with an unstable pelvic fracture, had a pelvic binder applied in the prehospital setting. Several physical exam findings and vital signs were associated with unstable pelvic fracture; these could be helpful for increasing prehospital identification of pelvic fractures.