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Pelvic Trauma

Date Last Search Run: Feb 01, 2022
Table last updated: Dec 14, 2021
Data last added: Dec 14, 2021

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)        
2 (fair evidence exists)    
3 (weak evidence exists)    


Interventions

Circumfrential Sheet
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Blood transfusion Process ED-MD Fu CY., Wu YT., Liao CH., et al. Pelvic circumferential compression devices benefit patients with pelvic fractures who need transfers. Am J Emerg Med 2013; 31(10):1432-6. Medline
II Supportive (Green) Mortality Patient ED-MD Pizanis A., Pohlemann T., Burkhardt M., Aghayev E., Holstein JH. Emergency stabilization of the pelvic ring: Clinical comparison between three different techniques. Injury 2013; 44(12):1760-4. Medline
II Neutral (Yellow) Guideline adherence Process ED-MD Toth L., King KL., McGrath B., Balogh ZJ. Efficacy and safety of emergency non-invasive pelvic ring stabilisation. Injury 2012; 43(8):1330-1334. Medline
III Supportive (Green) Effective injury reduction Patient SIM DeAngelis NA., Wixted JJ., Drew J., et al. Use of the trauma pelvic orthotic device (T-POD) for provisional stabilisation of anterior-posterior compression type pelvic fractures: a cadaveric study. Inj Int J Care Injured 2008; 39:903–6. Medline
III Supportive (Green) Pelvic ring closure Process Durão C, Alves M, Barros A, Pedrosa F. The importance of pelvic ring stabilization as a life-saving measure in pre-hospital - A case report commented by autopsy. Journal of clinical orthopaedics and trauma 2017; 8:S17-20. Medline
III Supportive (Green) Blood pressure Patient ED-MD Nunn T., Cosker D., Pallister I. Immediate application of improvised pelvic binder as first step in extended resuscitation from life-threatening hypovolaemic shock in conscious patients with unstable pelvic injuries. Inj Int J Care Injured 2007; 38:125–8. Medline
III Supportive (Green) Reduction Patient ED-MD Simpson T., Krieg JC., Heuer F., Bottlang M. Stabilization of Pelvic Ring Disruptions with a Circumferential Sheet. J Trauma 2002; 52:158-161. Medline
III Supportive (Green) Blood loss Patient ED-MD Spanjersberg WR., Knops SP., Schep NW. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature. Injury 2009; 1031–103. Medline

Corsette Style Compression Device (e.g. T-Pod)
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Transfusion Patient ED-MD Croce M., Magnotti L., Savage S.. Emergent Pelvic Fixation in Patients with Exsanguinating Pelvic Fractures. J Am Coll Surg 2007;1(59):935-9. Medline
II Supportive (Green) Blood transfusion Patient ED-MD Fu CY., Wu YT., Liao CH., et al. Pelvic circumferential compression devices benefit patients with pelvic fractures who need transfers. Am J Emerg Med 2013; 31(10):1432-6. Medline
II Neutral (Yellow) Safety Patient PH-Paramedic Pierrie SN, Seymour RB, Wally MK, Studnek J, Infinger A, Hsu JR. Pilot randomized trial of pre-hospital advanced therapies for the control of hemorrhage (PATCH) using pelvic binders. Am J Emerg Med 2021; 42:43-8. Medline
II Neutral (Yellow) Transfusion requirements Patient PH-Paramedic Schweigkofler U, Wohlrath B, Trentzsch H, Horas K, Hoffmann R, Wincheringer D. Is there any benefit in the pre-hospital application of pelvic binders in patients with suspected pelvic injuries? Eur J Trauma Emerg Surg 2021; 47(2):493-8. Medline
III Supportive (Green) Effective injury reduction Patient SIM DeAngelis NA., Wixted JJ., Drew J., et al. Use of the trauma pelvic orthotic device (T-POD) for provisional stabilisation of anterior-posterior compression type pelvic fractures: a cadaveric study. Inj Int J Care Injured 2008; 39:903–6. Medline
III Supportive (Green) Effective injury reduction Patient SIM Knops SP., Schep NW., Spoor CW., van Riel MP., Spanjersberg WR., Kleinrensink GJ., et al. Comparison of three different pelvic circumferential compression devices: a biomechanical cadaver study. J Bone Joint Surg Am 2011; 93:230–40. Medline
III Supportive (Green) Correct positioning Process ED-MD Naseem H., Nesbitt PD., Sprott DC., Clayson A. An assessment of pelvic binder placement at a UK major trauma centre. Ann R Coll Surg Engl 2018; 100(2) 101-5. Medline
III Supportive (Green) Effectiveness Process Reynard FA., Flaris AN., Simms ER., et al. Kendrick's extrication device and unstable pelvic fractures: Should a trochanteric belt be added? A cadaveric study. Injury. 2016;47(3):711-6. Medline
III Supportive (Green) - Process ED-MD Schweigkofler U., Wohlrath B., Trentsch H., Greipel J., Tamimi N., Hoffmann R., et al. Diagnostics and early treatment in prehospital and emergency-room phase in suspicious pelvic ring fractures. European journal of trauma and emergency surgery 2018; 44(5) 747-52. Medline
III Supportive (Green) Blood loss Patient ED-MD Spanjersberg WR., Knops SP., Schep NW. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature. Injury 2009; 1031–103. Medline
III Supportive (Green) Mean arterial pressure Patient ED-MD Tan EC., van Stigt SF., van Vugt AB. Effect of a new pelvic stabilizer (T-POD(R)) on reduction of pelvic volume and haemodynamic stability in unstable pelvic fractures. Injury 2010; 41:1239–43. Medline
III Opposes (Red) Exerted Surface Pressures Process SIM Knops SP., van Riel MP., Goossens RH., et al. Measurements of the exerted pressure by pelvic circumferential compression devices. Open Orthop J 2010; 4:101–6. Medline

External Mechanical Compression Device
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Blood transfusion Process ED-MD Fu CY., Wu YT., Liao CH., et al. Pelvic circumferential compression devices benefit patients with pelvic fractures who need transfers. Am J Emerg Med 2013; 31(10):1432-6. Medline
II Supportive (Green) Mortality Patient ED-MD Pizanis A., Pohlemann T., Burkhardt M., Aghayev E., Holstein JH. Emergency stabilization of the pelvic ring: Clinical comparison between three different techniques. Injury 2013; 44(12):1760-4. Medline
II Neutral (Yellow) Mortality Patient ED-MD Ghaemmaghami V., Sperry J., Gunst M., et al. Effects of early use of external pelvic compression on transfusion requirements and mortality in pelvic fractures. Am J Surg 2007; 194:720–3. Medline
II Neutral (Yellow) Use of Pelvic Binder Patient PH-MD & CCT Schweigkofler U, Wohlrath B, Trentzsch H, Horas K, Hoffmann R, Wincheringer D. Is there any benefit in the pre-hospital application of pelvic binders in patients with suspected pelvic injuries? Eur J Trauma Emerg Surg 2021; 47(2):493-8. Medline
II Neutral (Yellow) Guideline adherence Process ED-MD Toth L., King KL., McGrath B., Balogh ZJ. Efficacy and safety of emergency non-invasive pelvic ring stabilisation. Injury 2012; 43(8):1330-1334. Medline
III Supportive (Green) Intraperitoneal pressure Patient SIM Bottlang M., Simpson T., Sigg J., Krieg J., Madey S., LongW. Noninvasive Reduction of Open-Book Pelvic Fractures by Circumferential Compression. J Ortho Trauma 2002; 16(6):367-73. Medline
III Supportive (Green) Effective injury reduction Patient SIM Knops SP., Schep NW., Spoor CW., van Riel MP., Spanjersberg WR., Kleinrensink GJ., et al. Comparison of three different pelvic circumferential compression devices: a biomechanical cadaver study. J Bone Joint Surg Am 2011; 93:230–40. Medline
III Supportive (Green) Reduction in pelvic width Patient ED-MD Krieg JC., Mohr M., Ellis TJ., Simpson TS., Madey SM., Bottlang M. Emergent stabilization of pelvic ring injuries by controlled circumferential compression: A clinical trial. J Trauma 2005; 59(3):659-64. Medline
III Supportive (Green) Blood pressure Patient PH-Paramedic Vermeulen B., Peter R., Hoffmeyer P., Unger PF. Prehospital stabilization of pelvic dislocations: A new strap belt to provide temporary hemodynamic stabilization. Swiss Surg 1999; 5(2):43-46. Medline
III Neutral (Yellow) Successful reduction and stabilization Patient PH-Paramedic Quereshi A., McGee A., Cooper JP., et al. Reduction of the posterior pelvic ring by non-invasive stabilisation: a report of two cases. Emerg Med J 2005; 22:885–6. Medline
III Opposes (Red) Accuracy of placement Process PH-Paramedic Bonner TJ., Eardley WG., Newell N., et al. Accurate placement of a pelvic binder improves reduction of unstable fractures of the pelvic ring. J Bone Joint Surg Br 2011; 93:1524–8. Medline
III Opposes (Red) Pressures and pressure distribution Patient SIM Jowett AJ., Bowyer GW. Pressure characteristics of pelvic binders. Injury 2007; 38:118–21. Medline
III Opposes (Red) Exerted Surface Pressures Process SIM Knops SP., van Riel MP., Goossens RH., et al. Measurements of the exerted pressure by pelvic circumferential compression devices. Open Orthop J 2010; 4:101–6. Medline

MAST
Level Direction Primary Outcome Patient/Process Setting Reference
III Neutral (Yellow) Control of hemorrhage, survival, cause of death Process Bruining HA., Schattienkerk EM., De Vries JE., et al. Clinical experience with the medical anti-shock trousers(MAST) in the treatment of hemorrhage, especially from compound pelvic fracture. Netherlands J of Surgery 1980; 32:102-7. Medline


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