1. 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

2. Introduction Background Methods Results Discussion

3. Pelvic Fractures

4. Pelvic injuries associated with major trauma – Associated injuries

5. Pelvic Fractures

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

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

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

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

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

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

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

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

20. Results CT ScanX-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!