emergency management of pelvic fractures: an audit of practice before and after mtc status
DESCRIPTION
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. Introduction. Background Methods Results Discussion. Pelvic Fractures. - PowerPoint PPT PresentationTRANSCRIPT
Emergency Management of Pelvic Fractures: An audit of practice before and after MTC status
Royal Victoria Infirmary, Newcastle Upon Tyne, 2012-2014
Jonathan Barnes, Ramsey Refaie, Philip Thomas, Andrew Gray
Introduction
• Background• Methods• Results• Discussion
Pelvic Fractures
Pelvic Fractures
• Pelvic injuries associated with major trauma– Associated injuries
Pelvic Fractures
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
Pelvic BindersPelvic Stabilisation
•Reduce fracture
•Tamponade bleed
•Facilitate transfer
Quick, cheap, simple
Applied to all suspected pelvic fractures
Applied at greater trochanters (or just below)
• Question:
“How well are we using pelvic binders?”
“How are we investigating patients?”
“Has MTC status changed this?”
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
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
Methods
• Accurate placement– Binder at level of greater trochanters
• Exclusions– Isolated pubic ramus fractures– Transfers
Results
1 2 30
5
10
15
20
25
30
35
40
Pre MTC Status
Post MTC (0-6m)
Post MTC (12-18m)
Nu
mb
er o
f P
atie
nts
Total Admissions
Patients with binder
Total admissions and binder application rates before and after MTC status
*
Results
1 2 30
5
10
15
20
25
30
35
40
Pre MTC Status
Post MTC (0-6m)
Post MTC (12-18m)
Nu
mb
er o
f P
atie
nts
Total Admissions
Patients with binder
Total admissions and binder application rates before and after MTC status
*
Results
1 2 30
5
10
15
20
25
30
35
40
Pre MTC Status
Post MTC (0-6m)
Post MTC (12-18m)
Nu
mb
er o
f P
atie
nts
Total Admissions
Patients with binder
Total admissions and binder application rates before and after MTC status
*
Results
1 2 30
5
10
15
20
25
30
35
40
Pre MTC Status
Post MTC (0-6m)
Post MTC (12-18m)
Nu
mb
er o
f P
atie
nts
Total Admissions
Patients with binder
Total admissions and binder application rates before and after MTC status
*
Results
1 2 30
5
10
15
20
25
30
35
40
Pre MTC Status
Post MTC (0-6m)
Post MTC (12-18m)
Nu
mb
er o
f P
atie
nts
Total Admissions
Patients with binder
Total admissions and binder application rates before and after MTC status
*
* = p < 0.05
Results
• Binder accuracy:– Before MTC – 80%– After MTC (0-6m) – 92.4%– After MTC (12-18m) – 100%
ResultsCT Scan X-Ray
Pre MTC Status
Post MTC (0-6m)
Post MTC (12-18m)
ResultsCT Scan X-Ray
Pre MTC Status
Post MTC (0-6m)
Post MTC (12-18m)
ResultsCT Scan X-Ray
Pre MTC Status
Post MTC (0-6m)
Post MTC (12-18m)
* = p < 0.05
*
Conclusions
• Pelvic fractures = major trauma• Pelvic binders – simple and effective• More pelvic # post MTC
– Triage protocols– More major trauma
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
