Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, Geneva CH-1205, Switzerland.
Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, Geneva CH-1205, Switzerland.
Injury. 2024 Dec;55(12):111958. doi: 10.1016/j.injury.2024.111958. Epub 2024 Oct 15.
Application of a pelvic binder in the pre-hospital settings is a crucial step of high-energy blunt pelvic ring injury (PRI) management protocols. The aim of this retrospective cohort study was to evaluate the percentage of pre-hospital pelvic binder's applications in high-energy blunt type B or C PRI patients managed at a single level I trauma center, and to assess its impact on the medical resource requirements and patients' outcomes.
The institutional Severely Injured Patients' Registry was screened for patients meeting the following inclusion criteria: (1) high-energy blunt PRI; (2) admission between 2014.01.01 and 2022.12.31; (3) age ≥16 years; and (4) available computed tomography of the pelvis. Exclusion criteria were: (1) death before admission; (2) low-energy injury; (3) penetrating, blast and electrical injuries; and (4) secondary transfers. Study variables, including pre-hospital application of a pelvic binder and demographic, clinical, management and outcome data were extracted from the registry. Additionally, AO/OTA classifications were determined.
A consecutive series of 262 patients was included into the final analysis. Of these, 58.8 % received a pre-hospital pelvic binder (PPB), increasing from type A (45.1 %) to type B (57.8 %) and type C (73.7 %). Pre-hospital hemodynamic instability was a major factor triggering the use of PPB in high-energy blunt type B PRI patients with PPB in 76.9 % of the cases with hemodynamic instability vs. 51.3 % of the cases without hemodynamic instability (p = 0.009). This difference was not statistically significant for high-energy blunt type C PRI patients (82.8 % vs. 64.3 %, p = 0.200). The presence of a physician on the trauma site contributed to the increased percentage of PRI managed with PPB from 43.5 % to 67.3 % in type B PRI (p = 0.011), and from 50 % to 77.1 % in type C PRI (p = 0.257). This study showed an increased need for packed red blood cells (PRBC) transfusions in subgroups treated with PPB and no statistically significant differences in term of intensive care unit (ICU) and total hospital length of stay and complications between high-energy blunt type B or C PRI patients with or without PPB. Comparison of mortality rates in patients with and without PPB showed a trend towards lower mortality rates with PPB in patients with AIS extremity participating in at least 50 % of the total ISS.
In the ideal pre-hospital scenario, every high-energy blunt type B or C PRI patient should be managed with a PPB. Continuous pre-hospital team training and information is crucial to achieve this goal. The preparation of Emergency Department and ICU who admit a patient with PPB should include a sufficient number of PRBC ready for transfusion. Mortality rates did not seem to be affected by PPB, except for a trend towards lower mortality rates in patients in whom their PRI was the major component of the global severity of their injury. This might point out the critical and positive effect of PPB in high-energy blunt PRI patients.
在高能钝性骨盆环损伤（PRI）管理方案中，在院前环境中应用骨盆固定带是至关重要的一步。本回顾性队列研究的目的是评估在单一一级创伤中心管理的高能钝性 B 型或 C 型 PRI 患者中，院前应用骨盆固定带的比例，并评估其对医疗资源需求和患者预后的影响。
从严重创伤患者登记处筛选出符合以下纳入标准的患者：（1）高能钝性 PRI；（2）2014.01.01 至 2022.12.31 期间入院；（3）年龄≥16 岁；（4）骨盆 CT 可用。排除标准为：（1）入院前死亡；（2）低能量损伤；（3）穿透伤、爆炸伤和电击伤；（4）二次转院。从登记处提取研究变量，包括院前应用骨盆固定带和人口统计学、临床、管理和结果数据。此外，还确定了 AO/OTA 分类。
连续纳入了 262 名患者进行最终分析。其中，58.8%（155/262）接受了院前骨盆固定带（PPB），从 A 型（45.1%）增加到 B 型（57.8%）和 C 型（73.7%）。高能钝性 B 型 PRI 患者发生院前血流动力学不稳定是触发使用 PPB 的主要因素，其中 76.9%的病例存在血流动力学不稳定，而 51.3%的病例无血流动力学不稳定（p=0.009）。对于高能钝性 C 型 PRI 患者，这一差异无统计学意义（82.8%比 64.3%，p=0.200）。创伤现场有医生参与有助于增加使用 PPB 治疗的 PRI 比例，从 B 型 PRI 的 43.5%增加到 67.3%（p=0.011），从 C 型 PRI 的 50%增加到 77.1%（p=0.257）。本研究显示，在接受 PPB 治疗的亚组中，需要输注更多的浓缩红细胞（PRBC），但在 B 型或 C 型高能钝性 PRI 患者中，接受或不接受 PPB 治疗的患者在 ICU 和总住院时间和并发症方面，差异无统计学意义。比较有和无 PPB 的死亡率显示，在 AIS 四肢参与至少 50%的总 ISS 的患者中，使用 PPB 后死亡率有降低的趋势。
在理想的院前环境中，每一位高能钝性 B 型或 C 型 PRI 患者都应使用 PPB 进行治疗。持续的院前团队培训和信息是实现这一目标的关键。接受 PPB 的患者的急诊室和 ICU 的准备应包括足够数量的 PRBC 以备输血。死亡率似乎不受 PPB 的影响，但在 PRI 是其全身严重程度主要组成部分的患者中，死亡率有降低的趋势。这可能表明在高能钝性 PRI 患者中，PPB 具有关键和积极的作用。
