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

Abstract

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.