Title: Use of pelvic binders in the prehospital setting: A systematic review.

Authors: Rawaan, Brodie, Ian

Keywords: Trauma, prehospital, binders

Abstract: 

Introduction:

Pelvic binders (PB), also known as pelvic circumferential compression devices, are used in the prehospital setting to immobilize suspected pelvic fractures to reduce significant hemorrhage. Despite this, a lack of data exists on the prehospital use of PB. This study aims to review the current evidence surrounding commercial and non-commercial PB application in the prehospital trauma setting.

Method: We searched MEDLINE and EMBASE from inception to September 6th, 2022, using a structured search strategy around keywords “Trauma,” “Binder,” and “Pelvic.” Studies were included if they had an English abstract and examined the use of PB to treat suspected pelvic fractures in the prehospital setting. Two reviewers independently screened articles for inclusion and performed data extraction using a pre-determined form. Standardized tools were used to determine risk of bias depending on study design of the included studies. The following domains were evaluated: outcome, confounding, participant selection, classification of intervention, deviation from intervention, missing data, and outcome measurement. Results were categorized based on study type. No meta-analysis was performed based on significant heterogeneity between studies and high risk of bias.

Results:

Our search identified a total of 2125 studies. Of these 44 studies met our inclusion criteria and were included. These studies included 15 retrospective cohort studies, four prospective cohort studies, one pre-post study, one case-control study, one clinical trial, one interventional study, and 20 case reports/series. All studies were evaluated as moderate to critical risk of bias. There were a total of 4206 patients among the 44 included studies, 1725 (41%) had a PB placed in the prehospital trauma setting for a pelvic fracture. The type of PB used was not reported in the majority (36/44, 82%) of the studies. A SAM splint was reported to be used in 372 cases (22%). Pelvic binder placement was reported in 7/44 studies (16%), of which 282 (16%) were placed correctly.

Conclusion: The evidence for the use of PB in the prehospital setting for the stabilization of pelvic fractures is limited, with significant risk of bias. Current evidence suggests that PB are often placed incorrectly. Further research is needed to investigate the optimal use of these devices for prehospital trauma patients.