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Three Part Question

In [trauma patients with unstable pelvic fractures] is [pelvic immobilisation with a T-POD or pelvic immobilisation with a wrapped sheet] better [at haemorrhage control]?

Clinical Scenario

A patient is brought to the Emergency Department with pelvic trauma. One of the members of the trauma team mentions that the new T-POD pelvic binder is better at controlling internal haemorrhage than the traditional wrapped sheet. You wonder if there is any evidence to support this?

Search Strategy

Medline 1980 - May 2011 using the NHS library interface. [[Pelvis ti.ab OR Pelvic ti.ab] AND [Splint ti.ab. OR immobilisation ti.ab.] AND [Trauma ti.ab]] OR [Tpod ti.ab]


Medline 1980-February 7th 2013 using NHS Evidence
(TPOD ti,ab OR T-POD.ti,ab OR trauma pelvic orthotic device.ti, ab) = 13 records


Embase 1980-Feb 7th 2013
15 records no new relevancies

The Cochrane Library Issue 1 of 12 Jan 2013
TPOD ti,ab OR T-POD.ti,ab OR trauma pelvic orthotic device.ti, ab 2 records no new relevancies

Search Outcome

This search yielded 19 papers. No paper directly answered the question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

The study by Tan et al, which showed an increase in MAP and a reduction in heart rate after the application of the T-POD, provides some evidence for a tamponnade effect and an arrest to further deterioration.

Editor Comment

BAF currently working on it to submit March 2013

Clinical Bottom Line

Insufficient evidence currently exists to recommend the T-POD over the traditional wrapped bed sheet. A large, prospective, randomised controlled study is required to assess the safety and efficacy of PCCD. Local guidelines should be followed?

References

1. Tan ECTH, van Stigt SFL, van Vugt AB Effect of a new pelvic stabilizer (T-POD) on reduction of pelvic volume and haemodynamic stability in unstable pelvic fractures. Injury 2010; 41(12):1239-1243.