Comparison of the AO/OTA 1996/2007 and 2018 pelvic ring fracture classifications.

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Abstract

[Indexed for MEDLINE] 16. Injury. 2023 Apr;54(4):1163-1168. doi: 10.1016/j.injury.2023.02.015. Epub 2023 Feb 7. Prehospital accuracy of (H)EMS pelvic ring injury assessment and the application of non-invasive pelvic binder devices. Carvalho Mota MT(1), Goldfinger VP(2), Lokerman R(3), Terra M(4), Azijli K(2), Schober P(5), de Leeuw MA(5), van Heijl M(6), Bloemers FW(4), Giannakopoulos GF(4). Author information: (1)Department of Trauma Surgery, Amsterdam University Medical Centres, Room 7F-002, De Boelelaan 1117, 1081 HV, the Netherlands. Electronic address: m.carvalhomota@amsterdamumc.nl. (2)Department of Emergency Medicine, Amsterdam University Medical Centres, Room 7F-002, De Boelelaan 1117, 1081 HV, the Netherlands. (3)Department of Surgery, University Medical Centre Utrecht, the Netherlands. (4)Department of Trauma Surgery, Amsterdam University Medical Centres, Room 7F-002, De Boelelaan 1117, 1081 HV, the Netherlands. (5)Department of Anaesthesiology, Amsterdam University Medical Centres, Room 7F-002, De Boelelaan 1117, 1081 HV, the Netherlands. (6)Department of Surgery, University Medical Centre Utrecht, the Netherlands; Department of Surgery, Diakonessenhuis Utrecht, the Netherlands. BACKGROUND: Pre-hospital application of a non-invasive pelvic binder device (NIPBD) is essential to increase chances of survival by limiting blood loss in patients with an unstable pelvic ring injury. However, unstable pelvic ring injuries are often not recognized during prehospital assessment. We investigated the prehospital (helicopter) emergency medical services ((H)EMS)' accuracy of the assessment of unstable pelvic ring injuries and NIPBD application rate. METHODS: We performed a retrospective cohort study on all patients with a pelvic injury transported by (H)EMS to our level one trauma centre between 2012 and 2020. Pelvic ring injuries were included and radiographically categorized using the Young & Burgess classification system. Lateral Compression (LC) type II/III -, Anterior-Posterior (AP) type II/III - and Vertical Shear (VS) injuries were considered as unstable pelvic ring injuries. (H)EMS charts and in-hospital patient records were evaluated to determine the sensitivity, specificity and diagnostic accuracy of the prehospital assessment of unstable pelvic ring injuries and prehospital NIPBD application. RESULTS: A total of 634 patients with pelvic injuries were identified, of whom 392 (61.8%) had pelvic ring injuries and 143 (22.6%) had unstable pelvic ring injuries. (H)EMS personnel suspected a pelvic injury in 30.6% of the pelvic ring injuries and in 46.9% of the unstable pelvic ring injuries. An NIPBD was applied in 108 (27.6%) of the patients with a pelvic ring injury and in 63 (44.1%) of the patients with an unstable pelvic ring injury. (H)EMS prehospital diagnostic accuracy measured in pelvic ring injuries alone was 67.1% for identifying unstable pelvic ring injuries from stable pelvic ring injuries and 68.1% for NIPBD application. CONCLUSION: The (H)EMS prehospital sensitivity of unstable pelvic ring injury assessment and NIPBD application rate is low. (H)EMS did not suspect an unstable pelvic injury nor applied an NIPBD in roughly half of all unstable pelvic ring injuries. We advise future research on decision tools to aid the routine use of an NIPBD in any patient with a relevant mechanism of injury. Copyright © 2023. Published by Elsevier Ltd. DOI: 10.1016/j.injury.2023.02.015