Prehospital Variables Do Not Reliably Identify Pelvic Fracture Morphologies Amenable to Pelvic Binder Application: A Retrospective Imaging Review.

Abstract

BackgroundPelvic binders are used in prehospital settings for early stabilization when pelvic fractures are suspected. Although a rapid and cost-effective tool, uncertainties persist regarding their use prior to radiological confirmation of pelvic fracture.MethodsA review of adult patients with a pelvic fracture requiring trauma team activation who were admitted to a tertiary trauma center between 2020 and 2023 was conducted. The radiological studies were reviewed by four consultant orthopedic surgeons and were classified according to whether the application of a pelvic binder would be mechanically favorable, neutral, or potentially unfavorable. The area under the curve (AUC) was calculated to evaluate the ability of specific physiologic and injury-related variables (hypotension, tachycardia, shock index, Injury Severity Score (ISS), Glasgow Coma Scale, and mechanism of injury) to discriminate pelvic fracture morphologies for which pelvic binder application would be favorable.ResultsA total of 298 patients were included in the current investigation. Of these patients, applying a pelvic binder was favorable in 17% of cases (95% CI: 13%-22%, N = 50), would be mechanically neutral in 28% of cases (95% CI: 23%-33%, N = 82), and was potentially unfavorable in 56% of cases (95% CI: 50%-61%, N = 166) (P < .001). All investigated variables demonstrated limited discriminatory ability for identifying patients for whom pelvic binder application was favorable, with most AUCs <0.60. The highest predictive performance was observed for the ISS [AUC (95% CI): 0.65 (0.58-0.73)].ConclusionIn trauma patients with CT-confirmed pelvic ring injuries, readily available prehospital variables such as hemodynamic instability, associated injury patterns, and mechanism of injury appear to be insufficient for reliably identifying patients with a fracture morphology that could be amenable to pelvic binder application.