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REDUCING OVERTRIAGE AND UNDERTRIAGE RATES OF PELVIC FRACTURES AND UNNECESSARY PELVIC BINDER APPLICATIONS IN MAJOR TRAUMA PATIENTS
  1. Hannah Trebilcock
  1. South Western Ambulance Service NHS Foundation Trust, Exeter UK

Abstract

Background Data has been collected from suspected major trauma patient clinical records since the launch of the major trauma system in the South West in April 2012. In an internal report it was identified that 50% of overtriaged suspected major trauma patients were attributed to a suspected pelvic fracture. The National Consensus Statement on the Pre-Hospital Management of Pelvic Fractures provided a flow diagram depicting the appropriate application of the pelvic binder.

Method An audit was conducted looking at all suspected major trauma patients from April 2012–March 2013. Two groups were selected for the audit. Group 1 consisted of the overtriaged patients where a SAM splint had been applied. Group 2 consisted of the undertriaged patients identified by TARN as having a pelvic fracture where no binder was applied. The flow diagram sited in the consensus statement was retrospectively applied to both groups of patients to confirm whether following the criteria would result in more accurate pelvic binder applications.

Results In group 1, after applying the criteria specified in the flow diagram, there was a 15% reduction in unnecessary pelvic binder applications. In group 2 73% of the patients required a pelvic binder in accordance with the flow diagram criteria. Thus reducing the number of patients both over and under triaged with a pelvic fracture.

Conclusions Applying the flow diagram criteria has shown to improve accuracy of appropriate pelvic binder applications in suspected major trauma patients. The flow diagram has been summarised into four key points and included in a new Trust Clinical Guideline for pelvic injury. A follow up audit will be conducted looking at the same groups of patients in the year following publication of the guideline to analyse whether accuracy of pelvic binder applications has increased.

  • emergency department

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