Haemodynamics as a determinant of need for pre-hospital application of a pelvic circumferential compression device in adult trauma patients

McCreary, David; Cheng, Chris-Tin; Lin, Zhen; Nehme, Ziad; Fitzgerald, Mark; Mitra, Biswadev

doi:10.1016/j.injury.2019.08.001

Cited by 7 publications

(7 citation statements)

References 33 publications

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“…Our rate of patients with significant fractures and no binder placed is similar to the 31% described in a recent study 36 in a setting with also a low threshold for PCCD application in the field. Our higher rate of PCCD application for patients with pelvic ring www.nature.com/scientificreports www.nature.com/scientificreports/ injury comes with the cost of a higher overtriage rate, as only 14% of patients with PCCDs placed in the field in our study had a significant pelvic fracture, compared to 40% in the study by Yong et al 36 , and 36% in the study by McCreary et al 26 .…”

Section: Discussioncontrasting

confidence: 55%

“…On the other hand, one out of four patients with a final diagnosis of a significant pelvic ring injury had no PCCD applied. Several studies have specifically addressed prehospital PCCD application 13,25,26,36 . The majority of data available from the literature originate from in-hospital studies which show a favorable effect of PCCDs for fracture stabilization 10,37-42 , whereas only a few studies suggest a benefit in terms of hemodynamics, bleeding, or mortality [43][44][45] .…”

Section: Discussionmentioning

confidence: 99%

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Prehospital use of pelvic circumferential compression devices in a physician-based emergency medical service: A 6-year retrospective cohort study

Zingg¹,

Piaget-Rossel

Steppacher

et al. 2020

Sci Rep

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Fractures of the pelvic ring are a potential source of significant bleeding. Pelvic circumferential compression devices (PCCDs) can reduce and immobilize unstable fractures, but their hemostatic effect is unproven. Our aim was to assess the current practice of prehospital PCCD application and to identify factors available in the field predictive of significant pelvic ring injuries. All interventions (n = 13,435) in the Lausanne University Hospital Emergency Medical Service (EMS) were screened for PCCD placements from January 2008 to November 2014. Significant pelvic ring injuries (Tile types B or C) were considered as potentially benefitting from a PCCD. Data were extracted from the local prehospital registry. During the study period, 2366 trauma missions were performed. A PCCD was applied to 552/2366 (23%) patients. Significant pelvic ring injuries were present in 105/2366 (4.4%). Factors associated with the presence of significant pelvic ring injury were increased respiratory rate (OR 1.04), prolonged capillary refill time (OR 2.11), increased shock index (OR 3.91), pedestrians hit by a vehicle (OR 2.19), and presenting with falls from more than 2 m (OR 1.91). Among patients with a significant pelvic ring injury, a PCCD was placed in 79 (75%) and omitted in 26 (25%). One sixth of patients with a PCCD had a final diagnosis of significant pelvic ring injury. Further studies are needed to better understand which patient-, or accident-related factors are associated with prehospital PCCD omission among patients with significant pelvic ring injury.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Prehospital use of pelvic circumferential compression devices in a physician-based emergency medical service: A 6-year retrospective cohort study

Zingg¹,

Piaget-Rossel

Steppacher

et al. 2020

Sci Rep

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“…The results showed that there were no significant differences in 7-day, 30-day, and overall mortality rates between the PEF and PB groups. Recent studies have recommended that PB be applied as soon as possible after injury for rapid volume reduction of the pelvic cavity 16 , 17 . This means that haemostatic modalities such as PPP, PA, and REBOA should be used as much as possible to stop haemorrhage, the cause of most deaths, and simultaneously, a procedure for volume reduction of the pelvic cavity applied as quickly as possible should be performed.…”

Section: Discussionmentioning

confidence: 99%

Comparison between external fixation and pelvic binder in patients with pelvic fracture and haemodynamic instability who underwent various haemostatic procedures

Jang

Bae

Kang

et al. 2022

Sci Rep

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Haemostatic procedures such as preperitoneal pelvic packing (PPP), pelvic angiography (PA), and internal iliac artery ligation are used for haemorrhage control in pelvic fracture patients with haemodynamic instability. Pelvic external fixation (PEF) and pelvic binder (PB) are usually applied with haemostatic procedures to reduce the pelvic volume. This study aimed to compare the clinical outcomes between patients who underwent PEF and PB. Among 173 patients with pelvic fracture admitted to the emergency room of three regional trauma centres between January 2015 and December 2018, the electronic charts of haemodynamically unstable patients were retrospectively analysed. Among the 84 patients included in the analysis, 20 underwent PEF with or without PB, and 64 underwent only PB. There were significant differences in tile classification and laparotomy between the PEF and PB groups (p = 0.023 and p = 0.032). PPP tended to be more frequently preformed in the PEF group (p = 0.054), whereas PA tended to be more commonly performed in the PB group than in the PEF group (p = 0.054). After propensity score matching to adjust for differences in patient characteristics and adjunct haemostatic procedure, there was no significant difference in 7-day, 30-day, and overall mortality rates between the PEF and PB groups (10.5% vs 21.1%, p = 0.660, 21.1% vs 26.3%, p = 1.000, and 26.3% vs 26.3%, p = 1.000). Cox proportional hazard regression analysis and multivariate analysis for correction of covariates (age, lactate, and abdominal injury) showed that PEF was not an independent factor for 30-day mortality compared with PB (adjusted hazard ratio, 0.526; 95% confidence interval, 0.092–3.002; p = 0.469). Among the volume reduction procedures performed with other haemostatic procedures in patients with pelvic fracture and haemodynamic instability, PEF did not significantly reduce the 30-day mortality rate compared to PB.

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“…Pelvic fractures can be classi ed according to the anatomical location or the mechanism of injury [3] and occur in 8% of major trauma patients and 15.7% of patients with an injury severity score > 15 [4]. These injuries can cause signi cant haemorrhage, with an overall mortality of 14-18% [4] which, in patients with unstable fractures can reach 40-42% [4,5] and 40-60% when associated with ring disruption and shock [6]. It is worth noting that in the recent years there has been an increase in the survival rate after pelvic fractures [7].…”

Section: Introductionmentioning

confidence: 99%

“…However, the clinical evaluation of the existence of a pelvic fracture can be di cult and unreliable. In fact, following the clinical examination and patient's symptoms alone, it seems that 11% of fractures are not properly identi ed [4]. Inappropriate placement of these devices could cause adverse events, such as low-pressure necrosis to the underlying soft tissues and anatomical lesions [4] skin break down, catastrophic myonecrosis and bilateral peroneal nerve palsy [7].…”

Section: Introductionmentioning

confidence: 99%

The application of pelvic binders in the pre-hospital setting for people with suspected pelvic fracture: a systematic review

Napoletano,

Coclite,

Latina

et al. 2023

Preprint

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Background The application of non-invasive pelvic circumferential compression devices (PCCDs), including pelvic binders, has shown to improve the position and stability of some types of pelvic fractures. To date the clinical efficacy of PCCDs application is still scarce and of poor quality. We assessed the clinical efficacy of pelvic binder pre-hospital in the management of pelvic fracture. Methods We systematically searched MEDLINE (PubMed), EMBASE and Cochrane CENTRAL up to June 2022. Two authors independently extracted data and appraised risk of bias using the Newcastle Ottawa Scale for observational studies. The quality of evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach. Results We included ten studies with a total of 2770 participants. None of the included studies showed a statistically significant difference in overall mortality, 48h or 30-day mortality in PCCD group compared to no PCCD, whereas a reduction of mortality was observed in favour of the group with early PCCD when compared to PCCD placement after diagnosis (adjusted OR 0.00326; p = 0.039). Adjusted estimates did not show a clear indication of the benefits of PCCDs application vs no-PCCDs on the need for massive transfusion. Patients who received early PCCD vs PCCD after diagnosis had significantly less blood transfusion requirements (p = 0.009). The main reported complication was skin necrosis related to the comparison early PCCD vs late PCCD placement. Conclusions Our results suggest a positive effect of the early application of PCCDs on overall mortality, however, randomized controlled trials are needed in order to confirm preliminary results observed in observational studies.

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Haemodynamics as a determinant of need for pre-hospital application of a pelvic circumferential compression device in adult trauma patients

Cited by 7 publications

References 33 publications

Prehospital use of pelvic circumferential compression devices in a physician-based emergency medical service: A 6-year retrospective cohort study

Prehospital use of pelvic circumferential compression devices in a physician-based emergency medical service: A 6-year retrospective cohort study

Comparison between external fixation and pelvic binder in patients with pelvic fracture and haemodynamic instability who underwent various haemostatic procedures

The application of pelvic binders in the pre-hospital setting for people with suspected pelvic fracture: a systematic review

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