Department of Visceral Surgery, Lausanne University Hospital - CHUV, Lausanne, Switzerland.
Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland.
Sci Rep. 2020 Mar 20;10(1):5106. doi: 10.1038/s41598-020-62027-6.
Fractures of the pelvic ring are a potential source of significant bleeding. Pelvic circumferential compression devices (PCCDs) can reduce and immobilize unstable fractures, but their hemostatic effect is unproven. Our aim was to assess the current practice of prehospital PCCD application and to identify factors available in the field predictive of significant pelvic ring injuries. All interventions (n = 13,435) in the Lausanne University Hospital Emergency Medical Service (EMS) were screened for PCCD placements from January 2008 to November 2014. Significant pelvic ring injuries (Tile types B or C) were considered as potentially benefitting from a PCCD. Data were extracted from the local prehospital registry. During the study period, 2366 trauma missions were performed. A PCCD was applied to 552/2366 (23%) patients. Significant pelvic ring injuries were present in 105/2366 (4.4%). Factors associated with the presence of significant pelvic ring injury were increased respiratory rate (OR 1.04), prolonged capillary refill time (OR 2.11), increased shock index (OR 3.91), pedestrians hit by a vehicle (OR 2.19), and presenting with falls from more than 2 m (OR 1.91). Among patients with a significant pelvic ring injury, a PCCD was placed in 79 (75%) and omitted in 26 (25%). One sixth of patients with a PCCD had a final diagnosis of significant pelvic ring injury. Further studies are needed to better understand which patient-, or accident-related factors are associated with prehospital PCCD omission among patients with significant pelvic ring injury.
骨盆环骨折是潜在的大出血源。骨盆环围压固定装置（PCCD）可减少和固定不稳定骨折，但止血效果尚未得到证实。我们的目的是评估院前 PCCD 应用的现状，并确定现场可用于预测骨盆环不稳定骨折的因素。2008 年 1 月至 2014 年 11 月，筛查了洛桑大学医院急诊医疗服务（EMS）中所有干预措施（n=13435）中 PCCD 的应用情况。认为潜在受益于 PCCD 的骨盆环损伤为 Tile 分型 B 或 C 型骨盆环损伤。数据从当地院前登记处提取。研究期间，共进行了 2366 次创伤任务。对 2366 例患者中的 552 例（23%）应用了 PCCD。2366 例患者中有 105 例（4.4%）存在骨盆环损伤。与骨盆环损伤显著相关的因素有呼吸频率增加（OR 1.04）、毛细血管再充盈时间延长（OR 2.11）、休克指数增加（OR 3.91）、行人被车辆撞击（OR 2.19）和坠落高度超过 2m（OR 1.91）。在骨盆环损伤显著的患者中，79 例（75%）放置了 PCCD，26 例（25%）未放置。有 PCCD 的患者中有六分之一最终诊断为骨盆环损伤显著。需要进一步研究以更好地了解哪些患者相关因素或事故相关因素与骨盆环损伤显著的患者院前 PCCD 遗漏有关。
