Pelvic circumferential compression devices for prehospital management of suspected pelvic fractures: a rapid review and evidence summary for quality indicator evaluation

Robin Pap; Rachel McKeown; Craig Lockwood; Matthew Stephenson; Paul Simpson

doi:10.1186/s13049-020-00762-5

Pelvic circumferential compression devices for prehospital management of suspected pelvic fractures: a rapid review and evidence summary for quality indicator evaluation

Scand J Trauma Resusc Emerg Med. 2020 Jul 13;28(1):65. doi: 10.1186/s13049-020-00762-5.

Authors

Robin Pap^{1

2}, Rachel McKeown³, Craig Lockwood⁴, Matthew Stephenson⁴, Paul Simpson³

Affiliations

¹ Joanna Briggs Institute, University of Adelaide, Adelaide, Australia. r.pap@westernsydney.edu.au.
² School of Health Sciences, Western Sydney University, Sydney, Australia. r.pap@westernsydney.edu.au.
³ School of Health Sciences, Western Sydney University, Sydney, Australia.
⁴ Joanna Briggs Institute, University of Adelaide, Adelaide, Australia.

Abstract

Background: Pelvic fractures, especially when unstable, may cause significant haemorrhage. The early application of a pelvic circumferential compression device (PCCD) in patients with suspected pelvic fracture has established itself as best practice. Ambulance services conduct corresponding performance measurement. Quality indicators (QIs) are ideally based on high-quality evidence clearly demonstrating that the desirable effects outweigh the undesirable effects. In the absence of high-quality evidence, best available evidence should be combined with expert consensus.

Objectives: The aim of the present study was to identify, appraise and summarize the best available evidence regarding PCCDs for the purpose of informing an expert panel tasked to evaluate the validity of the following QI: A patient with suspected pelvic fracture has a PCCD applied.

Methods: A rapid review of four databases was conducted to identify relevant literature published up until 9 June 2020. Systematic reviews, experimental, quasi-experimental and observational analytic studies written in English were included. One author was responsible for study selection and quality appraisal. Data extraction using a priori extraction templates was verified by a second reviewer. Study details and key findings were summarized in tables.

Results: A total of 13 studies were assessed to be eligible for inclusion in this rapid review. Of these, three were systematic reviews, one was a randomized clinical trial (crossover design), two were before-after studies, and seven were retrospective cohort studies. The systematic reviews included mostly observational studies and could therefore not be considered as high-level evidence. Overall, the identified evidence is of low quality and suggests that PCCD may provide temporary pelvic ring stabilization and haemorrhage control, although a potential for adverse effects exists.

Conclusion: Given the low quality of the best available evidence, this evidence would need to be combined with expert consensus to evaluate the validity of a related quality indicator before its implementation.

Keywords: Pelvic fracture; Prehospital care; Quality indicator; Rapid review; Trauma.

Publication types

Review

MeSH terms

Emergency Medical Services / methods*
Fractures, Bone / complications
Fractures, Bone / therapy*
Hemorrhage / etiology
Hemorrhage / prevention & control*
Humans
Orthopedic Procedures / standards*
Pelvic Bones / injuries*
Quality Indicators, Health Care*