Pelvic Binder Utilization in Combat Casualties: Does It Matter?

Abstract

Introduction The purpose of this study was to evaluate the utilization of pelvic binders, the proper placement of binders, and to determine any differences in blood product transfusions between combat casualties with and without a pelvic binder identified on initial imaging immediately after the injury. Methods We conducted a retrospective review of all combat-injured patients who arrived at our military treatment hospital between 2010 and 2012 with a documented pelvic fracture. Initial imaging (X-ray or computed tomography) immediately after injury were evaluated by 2 independent radiologists. Young-Burgess (YB) classification, pelvic diastasis, correct binder placement over the greater trochanters, and the presence of a pelvic external fixator (ex-fix) was recorded. Injury severity score (ISS), whole blood, and blood component therapy administered within the first 24-hours after injury were compared between casualties with and without a pelvic binder. Results 39 casualties had overseas imaging to confirm and radiographically classify a YB pelvic ring injury. The most common fracture patterns were anteroposterior (53%) and lateral compression (28%). 49% (19/39) did not have a binder or ex-fix identified on initial imaging or in any documentation after injury. Ten patients had a binder, with 30% positioned incorrectly over the iliac crest. ISS (34 ± 1.6) was not statistically different between the binder and the no-binder group. Pubic symphysis diastasis was significantly lower in the binder group (1.4 ± 0.2 vs 3.7 ± 0.5, P < .001). There was a trend toward decreased 24-hour total blood products between the binder and no-binder groups (75 ± 11 vs 82 ± 13, P = .67). This was due to less cryoprecipitate in the binder group (6 ± 2 vs 19 ± 5, P = .01). Conclusions Pelvic binder placement in combat trauma may be inconsistent and an important area for continued training. While 24-hour total transfusions do not appear to be different, no-binder patients received significantly more cryoprecipitate.

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

“…However, one study found that with very low certainty of evidence, patients with a PCCD placement in pre-hospital setting could signi cantly receive less blood transfusions (OR 0.63, 95%CI 0.41-0.95). A similar nding was found in other two studies with unadjusted data [24,26], where patients with PCCD placement received a lower quantity of transfused blood or cryoprecipitates.…”

“…The included studies allowed the following comparisons: (i) PCCD placement vs. No PCCD; (ii) early PCCD placement vs. late placement following a radiological assessment. As for setting, three studies [20,24,25] evaluated the use of PCCD in the pre-hospital setting, three studies in Emergency Department (ED) [19,26,27] and four studies both in the pre-hospital and in ED settings [18, [21][22][23]. General characteristics are reported in Table 1.…”

“…On the other hand, Fu and colleagues reported that patients who received pre-transfer PCCDs vs no pre-transfer PCCD required a lower quantity of transfused blood, both when the pelvic fracture was stable (p = 0.018) or unstable (p < 0.001). One study [24] investigated blood components transfusion requirement in patients with a prehospital PCCD vs no PCCD. No difference was found between the two groups for whole blood, PRBC, fresh frozen plasma or platelets transfusion, while the PCCD group signi cantly received less cryoprecipitate transfusions compared to patients with no PCCD (p = 0.01).…”

“…One pilot RCT [25] and nine observational studies were found. Two study were prospective [20,23] whereas all other studies were retrospective [18, 19,21,22,24,26,27]. The included studies allowed the following comparisons: (i) PCCD placement vs. No PCCD; (ii) early PCCD placement vs. late placement following a radiological assessment.…”