Prehospital pelvic binder use and transfusion requirements in patients with pelvic fractures: A nationwide propensity-matched cohort study.

Abstract

Pelvic binders are recommended for suspected pelvic fractures to provide early stabilization and hemorrhage control, but robust comparative evidence regarding their real-world impact on transfusion requirements and subsequent hemorrhage-control strategies remains limited. We evaluated the association between prehospital pelvic binder use, early transfusion requirements, and pelvic angioembolization in a nationwide trauma registry. We conducted a retrospective cohort study using the Japan Trauma Data Bank from 2019 to 2023. Adult patients with blunt pelvic fractures were included. One-to-three propensity score matching was used to adjust for confounding by indication. The primary outcome was 24-hour red blood cell transfusion volume. Secondary outcomes included in-hospital mortality and hemorrhage-control interventions, particularly pelvic angioembolization. Multivariable regression analyses and mixed-effects models were used to assess associations between prehospital pelvic binder use and outcomes. Among 10,332 eligible patients, 182 patients (1.8%) received a prehospital pelvic binder. After matching, 182 patients with prehospital pelvic binder use and 546 controls were analyzed. Median 24-hour red blood cell transfusion volume did not differ significantly between groups (2.0 [interquartile range, 0.0-10.0] vs. 0.0 [0.0-8.0] units; P = 0.486), and regression analyses showed no independent association between prehospital pelvic binder use and transfusion volume. In-hospital mortality was similar between groups. In contrast, prehospital pelvic binder use was associated with a higher rate of pelvic angioembolization (33.0% vs. 21.2%; odds ratio, 1.82; 95% confidence interval, 1.24-2.66; P = 0.002). Subgroup analyses, including patients with acetabular and proximal femur fractures, showed no evidence of effect modification. In this nationwide propensity-matched cohort of patients with blunt pelvic fractures, prehospital pelvic binder use was not associated with reduced 24-hour transfusion requirements or in-hospital mortality, but was associated with a higher rate of pelvic angioembolization. These findings suggest that prehospital pelvic binder use may influence, or reflect differences in, subsequent hemorrhage-control strategies rather than directly reducing transfusion requirements.