Utilization of pre-hospital pelvic circumferential compression devices for pelvic fractures: survey of U.S. level I trauma centers

Abstract

Introduction: There is a lack of data on the use and effectiveness of pre-hospital pelvic circumferential compression devices (PCCD) as a temporary intervention for pelvic fracture management; they are thought to decrease pelvic volume and hemorrhage but are not without risks. The purpose of this study is to examine prehospital PCCD practices at US Level I trauma centers. Methods: This was a prospective cross-sectional survey of trauma medical directors at US Level I trauma centers. The aim of this study was to describe patterns of pre-hospital PCCD utilization for pelvic fractures. Responses were compared by region, length in time the center was designated Level I, trauma patient volume, pelvic management guideline followed and blood product guidelines. Data were compared using Fisher's exact and chi-squared tests.Results: Of the 158 Level I trauma centers invited, 25% responded. All Level I trauma centers use in-hospital PCCDs, whereas 71% of participant's paramedic agencies trained on pre-hospital PCCD application. Of those, 44% trained to apply pre-hospital PCCDs to all suspected pelvic fractures. A higher proportion of high-volume centers (77%) than low-volume centers (25%) trained on pre-hospital PCCD placement, p = 0.06. PCCD practices were not dependent on the trauma center's region, trauma volume, length in time as a Level I trauma center, or pelvic fracture guideline followed.Conclusions: There is widespread application of in-hospital and pre-hospital PCCD at US Level I trauma centers, however pre-hospital PCCDs are not applied to all suspected pelvic fractures. Future studies should focus on efficacy, safety, and contraindications for pre-hospital PCCDs.

Pelvic Compression Device (Binder) Application Training in Medical Students: A Manikin Study

“…The use of pelvic compression devices such as binders is recommended as an early strategy to stabilize the pelvic ring and decrease the amount of pelvic hemorrhage in managing pelvic fractures (Coccolini et al, 2017; Jarvis et al, 2020; Pap et al, 2020). A study of inhospital and prehospital pelvic compression device use at U.S. Level I trauma centers found that prehospital pelvic compression devices were not applied to all suspected pelvic fractures (Jarvis et al, 2020). Similarly, Kuner found that only one-third of patients with pelvic fractures assigned to the resuscitation room of a Level I trauma center had a pelvic compression device applied (Kuner et al, 2021).…”