OTA mailing list thread:

"It's impossible to evaluate efficacy [...] if 'hemodynamically unstable' is inconsistently defined."

Adam Starr
Orthopedic Trauma Surgeon
Dallas, Texas

 

In the articles I've read about clamps and ex-fixes, the patients that are said to be saved by these devices are the patients who are "hemodynamically unstable". It's impossible to evaluate the efficacy of these devices if "hemodynamically unstable" is inconsistently defined.

To further trouble matters, the definition we use needs to be available early on in the patient's course. We need to be able to define "unstable" quickly. If it takes us an hour to tell who's unstable, the horse may be out of the barn.

Neither the AIS/ISS, the APACHE score, or the TRISS are available quickly.

Age, fracture pattern, RTS, base deficit, GCS, systolic blood pressure and (according to Wolfgang Ertel) lactate - these are available quickly.

If you use pelvic clamps or ex-fixes at your center, how do you decide who to put them on? Do you use fracture pattern? Age? Physiologic markers?

Adam Starr,
Dallas, Texas