Identification and Management of Pelvic Fractures in Prehospital and Emergency Department Settings.

INTRODUCTION: This study aims to describe the characteristics of patients with a pelvic fracture treated at a level 1 trauma center, the proportion of prehospital undertriage and the use of pelvic circumferential compression device (PCCD). METHODS: This is a retrospective cohort study. Prehospital and inhospital medical records of adults (≥16 y old) with a pelvic fracture who were treated at Hopital de l'Enfant-Jesus-CHU de Québec (Quebec City, Canada), a university-affiliated level 1 trauma center, between September 01, 2017 and September 01, 2021 were reviewed. Isolated hip or pubic ramus fracture were excluded. Data are presented using proportions and means with standard deviations. RESULTS: A total of 228 patients were included (males: 62.3%; mean age: 54.6 [standard deviation 21.1]). Motor vehicle collision (47.4%) was the main mechanism of injury followed by high-level fall (21.5%). Approximately a third (34.2%) needed at least one blood transfusion. Compared to those admitted directly, transferred patients were more likely to be male (73.0% versus 51.3%, P < 0.001) and to have a surgical procedure performed at the trauma center (71.3% versus 46.9%, P < 0.001). The proportion of prehospital undertriage was 22.6%. Overall, 17.1% had an open-book fracture and would have potentially benefited from a prehospital PCCD. Forty-six transferred patients had a PCCD applied at the referral hospital of which 26.1% needed adjustment. CONCLUSIONS: Pelvic fractures are challenging to identify in the prehospital environment and are associated with a high undertriage of 22.6%. Reducing undertriage and optimizing the use of PCCD are key opportunities to improve care of patients with a pelvic fracture.

Accuracy of Prehospital Trauma Triage to Select Older Adults Requiring Urgent and Specialized Trauma Care.

INTRODUCTION: This study aims to assess the sensitivity and specificity of a 5-step prehospital trauma triage protocol to identify older adults who require urgent and specialized trauma care using different age cut-offs to define an older adult (≥55, ≥65, and ≥75 y old). METHODS: Prehospital and in-hospital medical records were reviewed for injured patients transported by an ambulance to an emergency department (ED) between November 11, 2016 and March 3, 2017 in Quebec City, Canada. Sensitivities and specificities were calculated to assess the accuracy of our prehospital trauma triage protocol to identify patients who required at least one urgent in-hospital trauma intervention. RESULTS: A total of 822 patients were included of which 62.9% were ≥55 y old and 56.3% were female. Fall (65.8%) was the main trauma mechanism. Seventy-six (9.2%) patients required urgent trauma care. This proportion was similar regardless of age (8.9%-9.5%). The proportion of patients who needed to be transported to the level-1 trauma center as per the triage protocol tended to decrease with increasing age (20.6% [whole cohort], 15.3% [≥55 y old], 11.4% [≥65 y old], and 9.0% [≥75 y old]). The sensitivity of the protocol for steps 1, 2, and 3 was 56.6% (whole cohort) and 30.0% for patients aged ≥75 y. The specificity ranged between 83.1% (whole cohort) and 93.1% (≥75 y old). CONCLUSIONS: Our prehospital trauma triage protocol has insufficient sensitivity to identify patients with urgent trauma care needs, particularly in older adults.