Are pelvic binders an effective measure to lower mortality and decrease blood loss after high energy pelvic ring injuries? A systematic review.

Abstract

Introduction: Pelvic binders are routinely used in the pre-hospital management of high energy pelvic ring injuries with a low threshold for utilisation. Current literature is inconclusive regarding the effectiveness of pelvic binders in controlling haemorrhage and decreasing mortality. The aim of this study is to investigate whether using such devices decrease mortality, blood loss, pain and complications.

Method: A systematic review was carried out using modern era articles published between January 2016 and May 2024 on two databases, investigating the effectiveness of pelvic binders in trauma patients in decreasing mortality, blood product requirement, pain level and complication rate.

Results: Five retrospective cohort studies, one interventional study with retrospective control and one RCT compared early binder application to late/no application and were included for analysis. were included. No clear superiority of pelvic binder application, regarding blood product requirements, mortality, pain and complications was demonstrated. Overall mortality in binder groups was 17.4 % and 15.7 % in the no/late binder groups. Only one study found a statistically significant superiority of pelvic binders regarding mortality when adjusted for confounding variables. Overall patients transfused were 35.6 % in the binder group and 25 % in the no/late binder group. Three out of seven studies reported a significantly lower blood product requirement in pelvic binder groups.

Conclusion: There is no clear superiority of early pelvic binder application over no/late binder use. The evidence is limited and lacks larger RCTs. Current widespread use of pelvic binders should be reevaluated, and alternative/adjunct devices should be further investigated for their effectiveness.