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.

译文

骨盆环骨折是严重出血的潜在来源。骨盆周压装置 (PCCDs) 可以减少和固定不稳定的骨折,但其止血效果尚未得到证实。我们的目的是评估院前PCCD应用的当前实践,并确定可预测严重骨盆环损伤的领域中可用的因素。从2008年1月到2014年11月,对洛桑大学医院急诊医疗服务 (EMS) 的所有干预措施 (n   =   13,435) 进行了PCCD安置筛查。严重的骨盆环损伤 (B或C型瓷砖) 被认为可能受益于PCCD。数据从当地院前登记处提取。在研究期间,进行了2366次创伤检查。将PCCD应用于552/2366 (23%) 患者。105/2366 (4.4%) 存在明显的骨盆环损伤。与存在明显的骨盆环损伤相关的因素包括呼吸频率增加 (或1.04),毛细血管再充盈时间延长 (或2.11),休克指数增加 (或3.91),行人被车辆 (或2.19) 击中,以及从2 m (或1.91) 以上跌倒。在患有严重骨盆环损伤的患者中,在79 (75%) 中放置了PCCD,在26 (25%) 中省略了PCCD。六分之一的PCCD患者最终诊断为严重的骨盆环损伤。需要进一步的研究,以更好地了解在严重骨盆环损伤的患者中,哪些与患者或事故相关的因素与院前pcccd遗漏有关。

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