Emergency Management of Pelvic Fractures: An audit of practice before and after MTC status

1. Emergency Management of Pelvic Fractures: An audit of practice before and after MTC status Jonathan Barnes, Ramsey Refaie, Philip Thomas, Andrew Gray Royal Victoria Infirmary, Newcastle Upon Tyne, 2012-2014

2. Introduction • Background • Methods • Results • Discussion

3. Pelvic Fractures

4. Pelvic Fractures • Pelvic injuries associated with major trauma • Associated injuries

5. Pelvic Fractures

6. Pelvic Fractures • Pelvic injuries associated with major trauma • Associated injuries • Highly vascularised/multiple viscera • Risk of major haemorrhage/organ damage • High mortality/morbidity • CT more sensitive than X-Ray

7. Pelvic Binders • Pelvic Stabilisation • Reduce fracture • Tamponade bleed • Facilitate transfer Quick, cheap, simple Applied to all suspected pelvic fractures Applied at greater trochanters (or just below)

8. Question: “How well are we using pelvic binders?” “How are we investigating patients?” “Has MTC status changed this?”

9. Major Trauma Centre • Centralised services • Consultant led, access to surgery/radiology, major trauma protocol • RVI: • Northeast MTC • Adults/paeds • “Could save 450-600 lives per year” • MTC = increased workload, improved practice

10. Methods • Retrospective cohort analysis • All ED admission with pelvic # • Six months before/after MTC status • Six months one year on • Reviewed imaging: • Imaging type? • Pelvic binder? • Accurate placement

11. Methods • Accurate placement • Binder at level of greater trochanters • Exclusions • Isolated pubic ramus fractures • Transfers

12. Results Total admissions and binder application rates before and after MTC status * Total Admissions Number of Patients Patients with binder Pre MTC Status Post MTC (0-6m) Post MTC (12-18m)

13. Results Total admissions and binder application rates before and after MTC status * Total Admissions Number of Patients Patients with binder Pre MTC Status Post MTC (0-6m) Post MTC (12-18m)

14. Results Total admissions and binder application rates before and after MTC status * Total Admissions Number of Patients Patients with binder Pre MTC Status Post MTC (0-6m) Post MTC (12-18m)

15. Results Total admissions and binder application rates before and after MTC status * Total Admissions Number of Patients Patients with binder Pre MTC Status Post MTC (0-6m) Post MTC (12-18m)

16. Results Total admissions and binder application rates before and after MTC status * Total Admissions Number of Patients Patients with binder Pre MTC Status Post MTC (0-6m) Post MTC (12-18m) * = p < 0.05

17. Results • Binder accuracy: • Before MTC – 80% • After MTC (0-6m) – 92.4% • After MTC (12-18m) – 100%

18. Results CT Scan X-Ray Pre MTC Status Post MTC (0-6m) Post MTC (12-18m)

19. Results CT Scan X-Ray Pre MTC Status Post MTC (0-6m) Post MTC (12-18m)

20. Results CT Scan X-Ray * Pre MTC Status Post MTC (0-6m) Post MTC (12-18m) * = p < 0.05

21. Conclusions • Pelvic fractures = major trauma • Pelvic binders – simple and effective • More pelvic # post MTC • Triage protocols • More major trauma

22. Conclusions • Increased use of CT scan • Increased availability • Increased ED experience • More binders post MTC • Not immediate effect – learning curve • ?Increased ambulance availability/experience • ?Increased ED experience • Increased accuracy of binder placement

23. Thank you! Thank you