PMID- 38225602
OWN - NLM
STAT- MEDLINE
DCOM- 20240117
LR  - 20240118
IS  - 1757-7241 (Electronic)
IS  - 1757-7241 (Linking)
VI  - 32
IP  - 1
DP  - 2024 Jan 16
TI  - Imposter or knight in shining armor? Pelvic circumferential compression devices 
      (PCCD) for severe pelvic injuries in patients with multiple trauma: a 
      trauma-registry analysis.
PG  - 2
LID - 10.1186/s13049-023-01172-z [doi]
LID - 2
AB  - BACKGROUND: Pelvic Circumferential Compression Devices (PCCD) are standard in 
      hemorrhage-control of unstable pelvic ring fractures (UPF). Controversial data on 
      their usefulness exists. Aim of the study was to investigate whether prehospital 
      application of PCCD can reduce mortality and transfusion requirements in UPF. 
      METHODS: Retrospective cohort study. From 2016 until 2021, 63,371 adult severely 
      injured patients were included into TraumaRegister DGU((R)) of the German Trauma 
      Society (TR-DGU). We analyzed PCCD use over time and compared patients with 
      multiple trauma patients and UPF, who received prehospital PCCD to those who did 
      not (noPCCD). Groups were adjusted for risk of prehospital PCCD application by 
      propensity score matching. Primary endpoints were hospital mortality, 
      standardized mortality rate (SMR) and transfusion requirements. RESULTS: Overall 
      UPF incidence was 9% (N = 5880) and PCCD use increased over time (7.5% to 20.4%). 
      Of all cases with UPF, 40.2% received PCCD and of all cases with PCCD 
      application, 61% had no pelvic injury at all. PCCD patients were more severely 
      injured and had higher rates of shock or transfusion. 24-h.-mortality and 
      hospital mortality were higher with PCCD (10.9% vs. 9.3%; p = 0.033; 17.9% vs. 
      16.1%, p = 0.070). Hospital mortality with PCCD was 1% lower than predicted. SMR 
      was in favor of PCCD but failed statistical significance (0.95 vs. 1.04, 
      p = 0.101). 1,860 propensity score matched pairs were analyzed: NoPCCD-patients 
      received more often catecholamines (19.6% vs. 18.5%, p = 0.043) but required less 
      surgical pelvic stabilization in the emergency room (28.6% vs. 36.8%, p < 0.001). 
      There was no difference in mortality or transfusion requirements. CONCLUSION: We 
      observed PCCD overuse in general and underuse in UPF. Prehospital PCCD appears to 
      be more a marker of injury severity and less triggered by presence of UPF. We 
      found no salutary effect on survival or transfusion requirements. Inappropriate 
      indication and technical flaw may have biased our results. TR-DGU does not 
      contain data on these aspects. Further studies are necessary. Modular add-on 
      questioners to the registry could offer one possible solution to overcome this 
      limitation. We are concerned that PCCD use may be unfairly discredited by 
      misinterpretation of the available evidence and strongly vote for a prospective 
      trial.
CI  - (c) 2024. The Author(s).
FAU - Trentzsch, H
AU  - Trentzsch H
AUID- ORCID: 0000-0002-6395-6873
AD  - Institut fur Notfallmedizin und Medizinmanagement (INM), Klinikum der Universitat 
      Munchen, Ludwig-Maximilians-Universitat, Schillerstr. 53, 80336, Munich, Germany. 
      heiko.trentzsch@med.uni-muenchen.de.
FAU - Lefering, R
AU  - Lefering R
AUID- ORCID: 0000-0002-0141-1747
AD  - Institute for Research in Operative Medicine (IFOM), Faculty of Health, 
      University Witten/Herdecke, Cologne, Germany.
FAU - Schweigkofler, U
AU  - Schweigkofler U
AUID- ORCID: 0000-0001-9863-9109
AD  - Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main 
      Friedberger, Landstr. 430, 60389, Frankfurt am Main, Germany.
CN  - TraumaRegister DGU
LA  - eng
PT  - Journal Article
DEP - 20240116
PL  - England
TA  - Scand J Trauma Resusc Emerg Med
JT  - Scandinavian journal of trauma, resuscitation and emergency medicine
JID - 101477511
SB  - IM
MH  - Adult
MH  - Humans
MH  - *Fractures, Bone/surgery
MH  - Germany/epidemiology
MH  - Injury Severity Score
MH  - *Multiple Trauma/surgery/epidemiology
MH  - Registries
MH  - Retrospective Studies
PMC - PMC10790519
OTO - NOTNLM
OT  - Advanced trauma life support care
OT  - Emergency medical services
OT  - Emergency treatment
OT  - Multiple trauma
OT  - Pelvic binder
OT  - Pelvic ring injury
OT  - Registries
COIS- The authors declare that they have no competing interests.
EDAT- 2024/01/16 00:42
MHDA- 2024/01/17 06:42
PMCR- 2024/01/16
CRDT- 2024/01/15 23:36
PHST- 2023/08/24 00:00 [received]
PHST- 2023/12/15 00:00 [accepted]
PHST- 2024/01/17 06:42 [medline]
PHST- 2024/01/16 00:42 [pubmed]
PHST- 2024/01/15 23:36 [entrez]
PHST- 2024/01/16 00:00 [pmc-release]
AID - 10.1186/s13049-023-01172-z [pii]
AID - 1172 [pii]
AID - 10.1186/s13049-023-01172-z [doi]
PST - epublish
SO  - Scand J Trauma Resusc Emerg Med. 2024 Jan 16;32(1):2. doi: 
      10.1186/s13049-023-01172-z.