Objectives & Background Pre-hospital application of pelvic binders is recommended by the 2016 NICE guidelines for Major Trauma in any patient with blunt high-energy trauma and suspected active bleeding from a pelvic fracture. The Emergency Medical Retrieval Service (EMRS) provide a pre-hospital critical care team by road and air to for the West of Scotland to a mixed rural and urban catchment area. The EMRS SOP mandates pelvic binder application to patients with suspected pelvic fractures including all polytrauma with significant mechanism of injury. We aimed to ascertain the incidence of pelvic fractures in this group of patients and whether this mechanism predicted significant pelvic injury.
Methods Retrospective analysis of all trauma patients attended by EMRS between 2011 and 2015 who had a pelvic binder applied and were not declared dead at scene. 140 patients were identified – of these, 11 were excluded due to lack of access to imaging. Data was obtained from the EMRS database and in-hospital systems including TrakCare, Portal and PACS. Information was collected and analysed using Microsoft Excel. Parametric data was analysed using Students T-test and non parametric data was analysed using Mann-Whitney test on Stata v12.
Results Of the 129 trauma patients who had pelvic binders applied, 32 (25%) had evidence of active bleeding and 28 (22%) had a pelvic fracture identified on imaging. The ‘fracture present’ versus ‘fracture not present’ populations were compared. This data is summarised in Table 1. Most common mechanisms to cause pelvic fracture were being either the car occupant in an RTC (29% of fractures) or a pedestrian in an RTC (29%). Motorcyclists made up 19% of patients to whom a pelvic binder was applied, but they only represented 7% of the pelvic fracture population.
Conclusion Application of a pelvic binder to this group of patients seems an appropriate action as a significant proportion subsequently have a pelvic fracture identified on imaging. The population of pelvic fracture patients seen by EMRS are more commonly patients involved in road traffic collisions (as opposed to ‘falls from height’ seen more commonly in purely rural populations) with an ISS of more than 15 to constitute ‘major trauma’.
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