Natural History of the Pelvic Binder or “Sheet-wrap” in the Early Treatment of Patients with Life-threatening Pelvic Ring Injuries at a Busy Level One Regional Trauma Center. A Retrospective Study.

Abstract Objective: Pelvic binders and “sheet-wraps” (PB/SW) are critical tools in splinting the injured pelvis of severely injured trauma patients. Our study reviews the management, logistics, and documentation of PB/SW use in a busy academic Level 1 Trauma Center. Methods: Adults patients with pelvic ring injury from high energy trauma presenting with shock between July 1, 2015 and June 31, 2017 requiring the use of a PB/SW were included in the study, a retrospective review of the medical records was performed evaluating when, how, and by whom PB/SW’s were applied, removed, or manipulated during early hospitalization. Results: Documentation and management of PB/SW’s werewell below standard benchmarks of other procedures, tools, and interventions used in acutely ill patients. No information was documented about PB/SW application in 44% of the 36 cases when the PB/SW was applied at our center. Alterations to the PB/SW were ineffectually communicated and coordinated between members of the treatment team with all PB/SW removed from 21 of patients treated with an emergency procedure in interventional radiology (15) or the operating room (6). Conclusions: Our use and documentation of PB/SW’s in the early treatment of trauma patients with pelvic injuries in shock appear lacking. Immediate action will be taken to improve on these benchmarks through process improvement with caregiver education, improved communication, and creation of measurable benchmarks. Level of Evidence : Level IV. See Instructions for Authors for a complete descriptionof levels of evidence.