Pelvic Binders in Trauma Patients - Are We Doing it Right?

2021 ◽  
Author(s):  
Sush Ramakrishna Gowda
Keyword(s):  
High Energy ◽  
Trauma Centre ◽  
Pelvic Fractures ◽  
Trauma Patients ◽  
Pelvic Binder ◽  
Major Trauma Centre ◽  
Fracture Management ◽  
Education And Awareness ◽  
Pelvic Fracture Management ◽  
And Training

Introduction: Pelvic fractures from high-energy trauma require immediate stabilisation to avoid significant morbidity and mortality. When applied correctly over the level of the greater trochanters (GT) pelvic binders provide adequate stabilisation of unstable pelvic fractures. The aim of this study was to identify the accuracy of placement of pelvic binders in patients presenting to the local Major Trauma Centre (MTC). Methods: A retrospective study was carried out to assess the level of the pelvic binders in relation to the greater trochanters of the patient-classified as optimal or sub-optimal. Results: An initial review of the computed tomography (CT) trauma series in 28 consecutive patients with pelvic binders revealed that more than 50% of the pelvic binders were placed above the level of the GT, reducing the efficacy of the pelvic binders. A regional educational and training day was held with a focus on pelvic fracture management. Following this, a review was conducted on the placement of the pelvic binder in 100 consecutive patients. This confirmed a significant improvement in the position of the pelvic binder by over 70%. Conclusion: Inaccurately positioned pelvic binders provided suboptimal stabilisation of pelvic fractures. With education and awareness, there has been an improvement in the accuracy of pelvic binder placement in trauma patients. This study has highlighted the need for regular audit of current practice, in combination with regular education and training.

Pre-hospital and emergency department management of pelvic fractures and major trauma centre status: Has practice changed?

Trauma ◽  
2016 ◽  
Vol 19 (3) ◽  
pp. 207-211
Author(s):  
Jonathan Barnes ◽  
Philip Thomas ◽  
Ramsay Refaie ◽  
Andrew Gray
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Pelvic Fracture ◽  
Major Trauma ◽  
High Energy ◽  
Trauma Centre ◽  
Pelvic Fractures ◽  
Major Trauma Centre ◽  
Initial Imaging ◽  
One Year

Introduction Pelvic fractures are indicative of high-energy injuries and carry a significant morbidity and mortality and pelvic binders are used to stabilise them in both the pre-hospital and emergency department setting. Our unit gained major trauma centre status in April 2012 as part of a national programme to centralise trauma care and improve outcomes. This study investigated whether major trauma centre status led to a change in workload and clinical practice at our centre. Methods A retrospective analysis of all patients admitted with a pelvic fracture for the six-month periods before, after and at one-year following major trauma centre status designation. Data were retrospectively collected from electronic patient records and binder placement assessed using an accepted method. Patients with isolated pubic rami fractures were excluded. Results Overall, 6/16 (37.5%) pelvic fracture admissions had a binder placed pre-major trauma centre status, rising to 14/34 (41.2%) immediately post-major trauma centre status and 22/32 (68.8%) ( p = 0.025) one year later. Binders were positioned accurately in 4 patients (80%, one exclusion) pre-major trauma centre status, 12 (92.4%) post-major trauma centre status and 22 (100%) at one year. CT imaging was the initial imaging used in 9 (56.3%) patients pre-major trauma centre status, 29 (85.3%) ( p = 0.04) post-major trauma centre status and 27 (84.4%) at one year. Discussion Pelvic fracture admissions doubled following major trauma centre status. Computed tomography, as the initial imaging modality, increased significantly with major trauma centre status, likely a reflection of the increased resources made available with this change. Although binder application rates did not change immediately, a significant improvement was seen after one year, with binder accuracy increasing to 100%. This suggests that although changes in clinical practice often do not occur immediately, with the increased infrastructure and clinical exposure afforded through centralisation of trauma services, they will occur, ultimately leading to improvements in trauma patient care.

scholarly journals 989 Sustained and Further Improvements in Management of Open Fractures at a UK Major Trauma Centre

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Ramjeeawon ◽  
M Iqbal ◽  
E Abourisha ◽  
A Ahmad ◽  
Y Hasan ◽  
...  
Keyword(s):  
Junior Doctor ◽  
Hospital Management ◽  
Trauma Centre ◽  
Open Fractures ◽  
Management Guidelines ◽  
The Third ◽  
Management Standard ◽  
Major Trauma Centre ◽  
Fracture Management ◽  
Education And Awareness

Abstract Aim To re-audit pre-operative hospital management of open fractures following further interventions (junior doctor education and awareness, editing of trauma clerking form), after the initial audit and interventions led to improvements in all parameters. Method Pre-operative hospital management of open fractures was audited by reviewing patient notes using standards from the NICE (NG37) and BOAST/BAPRAS open fracture management guidelines. Patients included were treated by doctors with full exposure to the further interventions (due to junior doctor changeover the third cycle included fewer patients). Results All parameters remained improved in the third audit cycle compared to the first (before interventions were implemented). The following results compare the second (n = 30) and third audit (n = 14) cycles. Patients receiving correct antibiotics (96%vs100%) and in a timely manner (<2 hours) where not given pre-hospital (46%vs60%) improved. Initial neurovascular assessment (93%vs100%), specifying nerves assessed (60%vs71%), assessing all relevant arteries (60%vs71%) and nerves (63%vs71%) and using Medical Research Council (MRC) grading in nerve assessment (3%vs71%) improved, while specifying arteries assessed was similar (87%vs86%). Post-manipulation, neurovascular assessment (93%vs75%) and appropriate nerve examination (90%vs50%) deteriorated, however appropriate vascular assessment (60%vs75%) and use of MRC grading in nerve assessment (0%vs50%) improved. Documentation where neurovascular assessment was not possible, initially (50%vs93%) and post-manipulation (40%vs50%) improved. Photo availability deteriorated (70%vs64%). Tetanus cover (87%vs100%) and appropriate dressing use (47%vs71%) improved. Conclusions Most parameters showed sustained and further improvements. The haemodynamic stability variation of these patients may create difficulties in fully adhering to the management standard; in some cases, other acute concerns may take priority.

scholarly journals 1065 Exposing the Incidence of Ileus in Pelvic and Acetabular Fractures: A Retrospective Case Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Ward ◽  
R Ahmed ◽  
J Adedeji ◽  
J McGregor-Riley
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
High Energy ◽  
Trauma Centre ◽  
Acetabular Fractures ◽  
Retrospective Case ◽  
Visceral Injury ◽  
Bowel Surgery ◽  
Major Trauma Centre ◽  
Fracture Management

Abstract Background Paralytic ileus is a temporary inhibition of gastrointestinal mobility in the absence of mechanical obstruction. Ileus has previously been observed in up to 40% of patients undergoing bowel surgery, leading to increased morbidity and length of stay. Pelvic and acetabular fractures are often caused by high energy trauma and are associated with a risk of visceral injury. This is the first study to report the incidence of and risk factors for ileus following admission with pelvic and/or acetabular fractures. Method All patients over the age of 16 presenting to a major trauma centre throughout 2019 were included. Data included patient demographics, injury pattern, fracture management and presence of ileus. Previous studies identified patients as having ileus if they failed to tolerate an oral diet and open their bowels for more than three days (GI-2). Analysis assessed risk factors for ileus as well as its effect on length of stay. Results An incidence of ileus of 40.35% was observed in the 57 included patients. Ileus was three times more common in patients with a diagnosis of diabetes mellitus (p = 0.56) and 2.5 times more common in the presence of an open pelvic/acetabular fracture (p = 0.73). Length of stay was significantly longer in patients under 65 years identified as having ileus (p = 0.046). Gender, age, opiate use, fracture management and surgical approach were not identified as risk factors. Conclusions The authors have identified the essentiality of early risk factor identification and hope to encourage further research to create a prognostic tool.

Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre

2014 ◽  
Vol 32 (7) ◽  
pp. 535-538 ◽  
Author(s):  
Shahram Paydar ◽  
Armin Ahmadi ◽  
Behnam Dalfardi ◽  
Alireza Shakibafard ◽  
Hamidreza Abbasi ◽  
...  
Keyword(s):  
High Energy ◽  
Trauma Centre ◽  
Economic Effects ◽  
Trauma Patients ◽  
Radiological Evaluation ◽  
High Energy Trauma ◽  
Level 1

Comparison of routine blood alcohol tests and ICD-10-AM coding of alcohol involvement for major trauma patients

2021 ◽  
pp. 183335832110371
Author(s):  
Georgina Lau ◽  
Belinda J Gabbe ◽  
Biswadev Mitra ◽  
Paul M Dietze ◽  
Sandra Braaf ◽  
...  
Keyword(s):  
Administrative Data ◽  
Major Trauma ◽  
Blood Alcohol Concentration ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Alcohol Involvement ◽  
Preventable Risk Factor ◽  
Major Trauma Centre ◽  
Icd 10

Background: Alcohol use is a key preventable risk factor for serious injury. To effectively prevent alcohol-related injuries, we rely on the accurate surveillance of alcohol involvement in injury events. This often involves the use of administrative data, such as International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) coding. Objective: To evaluate the completeness and accuracy of using administrative coding for the surveillance of alcohol involvement in major trauma injury events by comparing patient blood alcohol concentration (BAC) with ICD-10-AM coding. Method: This retrospective cohort study examined 2918 injury patients aged ≥18 years who presented to a major trauma centre in Victoria, Australia, over a 2-year period, of which 78% ( n = 2286) had BAC data available. Results: While 15% of patients had a non-zero BAC, only 4% had an ICD-10-AM code suggesting acute alcohol involvement. The agreement between blood alcohol test results and ICD-10-AM coding of acute alcohol involvement was fair ( κ = 0.33, 95% confidence interval: 0.27–0.38). Of the 341 patients with a non-zero BAC, 82 (24.0%) had ICD-10-AM codes related to acute alcohol involvement. Supplementary factors Y90 Evidence of alcohol involvement determined by blood alcohol level codes, which specifically describe patient BAC, were assigned to just 29% of eligible patients with a non-zero BAC. Conclusion: ICD-10-AM coding underestimated the proportion of alcohol-related injuries compared to patient BAC. Implications: Given the current role of administrative data in the surveillance of alcohol-related injuries, these findings may have significant implications for the implementation of cost-effective strategies for preventing alcohol-related injuries.

Orthopaedic assessment unit: a service model for the delivery of orthopaedic trauma care in a major trauma centre during the global pandemic (COVID-19)

2021 ◽  
Vol 103 (3) ◽  
pp. 167-172
Author(s):  
JW Lim ◽  
H Rehman ◽  
S Gaba ◽  
H Sargeant ◽  
IM Stevenson ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Trauma Care ◽  
Statistical Significance ◽  
High Standard ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Service Model ◽  
Global Pandemic ◽  
Major Trauma Centre ◽  
Assessment Unit

Introduction We describe a new service model, the Orthopaedic Assessment Unit (OAU), designed to provide care for trauma patients during the COVID-19 pandemic. Patients without COVID-19 symptoms and isolated musculoskeletal injuries were redirected to the OAU. Methods We prospectively reviewed patients throughput during the peak of the global pandemic (7 May 2020 to 7 June 2020) and compared with our historic service provision (7 May 2019 to 7 June 2019). The Mann–Whitney and Fisher Exact tests were used to test the statistical significance of data. Results A total of 1,147 patients were seen, with peak attendances between 11am and 2pm; 96% of all referrals were seen within 4h. The majority of patients were seen by orthopaedic registrars (52%) and nurse practitioners (44%). The majority of patients suffered from sprains and strains (39%), followed by fractures (22%) and wounds (20%); 73% of patients were discharged on the same day, 15% given follow up, 8% underwent surgery and 3% were admitted but did not undergo surgery. Our volume of trauma admissions and theatre cases decreased by 22% and 17%, respectively (p=0.058; 0.139). There was a significant reduction of virtual fracture clinic referrals after reconfiguration of services (p<0.001). Conclusions Rapid implementation of a specialist OAU during a pandemic can provide early definitive trauma care while exceeding national waiting time standards. The fall in trauma attendances was lower than anticipated. The retention of orthopaedic staff in the department to staff the unit and maintain a high standard of care is imperative.

P77 Type II PEG fractures: collar or no collar

2019 ◽  
Vol 90 (3) ◽  
pp. e42.2-e42 ◽  
Author(s):  
L Harris ◽  
S Arif ◽  
Z Brady ◽  
M Elliot ◽  
CH Lee ◽  
...  
Keyword(s):  
Major Trauma ◽  
Trauma Centre ◽  
The Body ◽  
Bony Union ◽  
Supporting Evidence ◽  
Single Centre ◽  
Patient Demographics ◽  
Major Trauma Centre ◽  
Fracture Management

ObjectivesType 2 peg fractures are known to have low fusion rates but most are elderly with comorbidities and not fit for surgery. Increasingly, clinicians want to stop using hard collars due to its complications, but with little supporting evidence. We aim to provide data to add to this debate.DesignSingle centre cohort study.Subjects145 consecutive patients referred to a Major Trauma Centre as type 2 peg fracture.MethodsAll patients referred with a suspected peg fracture between March 2015 and December 2017 were included. All imaging were assessed and case notes reviewed for patient demographics, fracture management, complications and outcomes.Results102 cases were peg fractures (mean age=80 years). 92 (90.2%) were managed conservatively with a hard collar (mean of 87 days). 37% developed symptoms from the collar, namely pain, stiffness and non-tolerance. Bony union was achieved in only 39.1% of patients with increasing age being an independent risk factor (p<0.001). Of the 56 patients who did not have bony union, there were no reported symptoms and 90% were discharged without a collar. 2 patients were offered but declined fixation and neither reported any on-going symptoms.ConclusionsThis study adds to the body of evidence that fusion rates are low, and collar complications are not insignificant when type 2 peg fractures are treated in a hard collar. However, outcomes are good regardless of union, potentially rendering the collar unnecessary. We aim to conduct a randomised prospective study to further investigate.

scholarly journals An assessment of pelvic binder placement at a UK major trauma centre

2018 ◽  
Vol 100 (2) ◽  
pp. 101-105 ◽  
Author(s):  
H Naseem ◽  
PD Nesbitt ◽  
DC Sprott ◽  
A Clayson
Keyword(s):  
Computed Tomography ◽  
Continuing Education ◽  
Retrospective Review ◽  
Major Trauma ◽  
Pelvic Ring ◽  
Trauma Centre ◽  
Pelvic Ring Injury ◽  
Pelvic Ring Injuries ◽  
Pelvic Binder ◽  
Major Trauma Centre

Introduction Pelvic binders are used to reduce the haemorrhage associated with pelvic ring injuries. Application at the level of the greater trochanters is required. We assessed the frequency of their use in patients with pelvic ring injuries and their positioning in patients presenting to a single major trauma centre. Methods A retrospective review of our trauma database was performed to randomly select 1000 patients for study from April 2012 to December 2016. Patients with a pelvic binder or a pelvic ring injury defined by the Young and Burgess classification were included. Computed tomography was used to identify and measure pelvic binder placement. Results 140 patients were identified: 110/140 had a binder placed. Of the total, 54 (49.1%) patients had satisfactory placement and 56 (50.9%) had unsatisfactory placement; 30/67 (44.8%) patients with a pelvic ring injury had no binder applied, of whom 6 (20%) had an unstable injury; 9/67 patients died. Discussion This is the first study assessing pelvic binder placement in patients at a UK major trauma centre. Unsatisfactory positioning of the pelvic binder is a common problem and it was not used in a large proportion of patients with pelvic ring injuries. This demonstrates that there is a need for continuing education for teams dealing with major trauma.

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