T. Miles1, S.K. Larson1, A. Jackson2, S. Wisniewski2, F. Guyette2, J. Sperry2, J. Brown2, E. Fox3, B. Cotton3, D. Ostermayer3, B. Harbrecht4, B. Joseph5, E. Moore6, M. Schreiber7, M. Patel8, L. Tatebe9, C. Wilson1 1Baylor College Of Medicine, Houston, TX, USA 2University Of Pittsburg, Pittsburgh, PA, USA 3Memorial Hermann Hospital, Houston, TX, USA 4University Of Louisville, Louisville, KY, USA 5University Of Arizona, Tucson, AZ, USA 6Denver Health Medical Center, Aurora, CO, USA 7Oregon Health And Science University, Portland, OR, USA 8Vanderbilt University Medical Center, Nashville, TN, USA 9Feinberg School Of Medicine – Northwestern University, Chicago, IL, USA
Introduction: Prehospital interventions performed by Emergency Medical Services (EMS) providers have the potential to decrease morbidity & mortality in traumatically injured patients. Application of a pelvic binder has been shown to improve hemodynamic stability & decrease need for transfusion of blood products in trauma patients with unstable pelvic fractures. This study investigates whether application of pelvic binders in the prehospital setting is associated with improved patient outcomes..
Methods: A retrospective study of data from 8 trauma centers, the Linking Investigators in Trauma & Emergency Services (LITES) network, was performed. Included patients were at least 15 years old with unstable pelvic fractures (Figure 1). Patients who had pelvic binders placed in the prehospital setting were matched based on exact pelvic fracture ICD-10 code, AIS Abdomen, AIS Lower Extremity, and initial field Shock Index. The primary outcome was patient survivial; secondary outcomes included 24-hour mortality & volume of blood products.
Results: 116 patients had pelvic binders placed in the field. 76 patients were able to be precisely matched with control patients for comparision. The demographsics of the two groups were largely similar (Figure 2). Overall survival was not significantly different. Cox proportional hazard ratio for patients who received pelvic binders was 1.23 unadjusted and 0.71 when adjusted to control for blood colume transfused in the prehospital setting (p=0.6). When adjusted for prehospital administration of blood products, volume of blood transfusion was also not different between the two groups.
Conclusion: In-hospital application of pelvic binders is associated with improved mortality, but prehospital application of pelvic binders was not associated with improved mortality. Limitations of this study included relatively infrequent use of prehospital binders and the retrospective nature. More robust prospective study is needed to determine whether this intervention is an effective tool for EMS.