Page 42 - JSOM Summer 2023

Practical Recommendations for
Prehospital Selection of
Pediatric Pelvic Circumferential Compression Devices

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Jose Reyes, MD ; Joseph Kelly, MD ;
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Oluwakemi Badaki-Makun, MD ; Jennifer Anders, MD *
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ABSTRACT
Introduction: Although the instances of Special Operations uncommon because they generally require anterior-posterior
Forces (SOF) medical providers treating pediatric pelvic frac- forces or crush injures, which are rare in children. Much more
tures are rare, such fractures are notable injuries in terror at- commonly, pediatric pelvic fractures are from lateral forces,
tacks and are at high risk for morbidity and mortality for the namely, children being struck in the side while crossing the
patient as well as stress for the provider. Presently, guidelines street. However, in vehicle-ramming attacks, the victims are
3,4
for pediatric-sized pelvic stabilization device application are more likely to be caught in pedestrian zones or fleeing, both of
limited to measured pelvic circumference. This study aims to which result in more people being struck from behind or head
inform more practical sizing guidelines. Methods: Subjects on, and/or being crushed, thereby subjecting the victims to the
aged 1 year to 14 years were enrolled. Subject height, weight, forces necessary to create unstable pelvic fractures.
pelvic circumference, and fit on the Broselow Pediatric Emer-
gency Tape™ (Armstrong Medical Industries), fit with the Current guidelines for prehospital management of unstable
Pediatric PelvicBinder™ (PelvicBinder), and fit with the small pelvic ring fractures includes the application of an impro-
SAM Pelvic Sling™ (SAM® Medical) were collected. The vised or commercial pelvic circumferential compression device
primary outcome was the proportion of subjects fitting each (PCCD) until orthopedic surgical fixation and management
device. Results: Sixty-five subjects were recruited; median age can be achieved. Epidemiological studies have shown that
was 5 years (interquartile range, 1–8 years); 40 (62%) sub- PCCD application is associated with decreased transfusion
jects were male. Ninety-one percent of subjects fit within the requirements and lengths of stay in the intensive care unit.
5,6
scale of the Broselow Tape (height <143-cm). One hundred Epidemiologic findings are supported by cadaver studies
percent of subjects with a height <143-cm had an appropriate demonstrating adequate circumferential pressures and pelvic
fit with the Pediatric PelvicBinder (95% confidence level [CI], ring closure. For pediatric patients with unstable pelvic ring
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91.8–100%), while 91.7% of subjects with a height >143-cm fractures, PCCDs have similarly been observed to provide ad-
fit the SAM Pelvic Sling (95%CI, 61.5–99.8%). Conclusions: equate stabilization. 9,10 Therefore, current recommendations
Providers should attempt to fit the Pediatric PelvicBinder for state that early application of PCCDs in the prehospital set-
children >1 year old with suspected unstable pelvic fracture ting should be considered until adequate surgical evaluation
who fall on the Broselow Tape (<143-cm). The small SAM Pel- is possible because of the ease of device application without
vic Sling should be used for those taller than 143-cm. restricting patient access to other necessary interventions for
additional injuries. 11
Keywords: pediatrics; pelvic fractures; pelvic stabilizer; ter-
rorist attacks Historically, circumferential pelvic compression in pediatric
populations was accomplished using adult pelvic stabilization
devices or improvised methods. Pediatric-specific stabilization
devices have recently become available commercially. Data re-
Introduction
garding prehospital use of these devices are currently limited
While unstable pediatric pelvis fractures and the incidences because of the rare nature of the injuries for which they are in-
of SOF medical providers treating children are both rare, dicated. In addition, manufacturer sizing guidelines are based
each represents a notable event in terms of potential mortal- on the measurement of the pelvic circumference, which is not
ity and morbidity for the patient and stress for the provider. a measurement readily available to prehospital providers in
Our goal is to give the SOF provider the tools and knowl- high-threat environments. In the emergent setting, obtaining
edge to treat such injuries quickly and with confidence. Pelvic circumferential measurement is time-consuming and requires
fractures have been found to be a leading cause of death and movement of the injured patient, which may be both painful
morbidity in vehicle-ramming attacks or intentional vehicu- and harmful. Overall, rolling a patient to obtain measurement
lar assaults, such as the attack on Bastille Day, 2016, in Nice, of the pelvic circumference would increase risk in situations
France. This type of attack has been seen across the globe, where stabilization at the earliest possible time is essential for
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from London (the London Bridge attack of 2017) to Israel prevention of morbidity and mortality, as well as provider
and has been an increasingly popular form of terrorist attack. safety. With these concerns in mind, this study sought to ex-
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In the civilian context, unstable pediatric pelvic fractures are plore potential correlations of more easily attained variables
*Correspondence to jander74@jhmi.edu
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1 Dr Jose Reyes is affiliated with Johns Hopkins University School of Medicine, Baltimore. Dr Joseph Kelly, Dr Oluwakemi Badaki-Makun, and
4 Dr Jennifer Anders are affiliated with the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore.
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