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Wed Oct 29 19:25:18 GMT 2008

The key factor is that although you can control for all home made or manufacture devices for patients with OBPF..........we can not control for patient pelvic volume and degree of exsanguination in the presence of a closed or open retro-peritoneum..........no matter what device is in place........patient anatomy and physiology are different.
My 2 cents
Duchesne
CharityOne,NO
Sent via BlackBerry by AT&T

-----Original Message-----
From: "McSwain, Norman E Jr." <nmcswai at tulane.edu>

Date: Wed, 29 Oct 2008 13:44:56 
To: Trauma &amp; Critical Care mailing list<trauma-list at trauma.org>
Subject: RE: Fwd: Pelvic fractures

I guess I did not state the  question properly. I wanted to see some type of data that the sling type device does anything to benefit the patient: reduce blood loss, reduce pain, reduce length of stay, reduce mortality vs doing nothing at all. The only device that I have seen data to support in the PASG in a study done by Flint several years ago. There are other studies using PASG for hemorrhage control that demonstrate effectiveness. Burgess sent out the comparative study on unstable patients by Croce shows a reduction of transfusion requirements when compared to external fixation and a reduced hospitalization. The effectiveness was similar to the PASG

My concern is that there are no studies that demonstrate ANY altered outcome on the patients who arrive in the ED with a simple pelvic fracture. Would they not be just as well off if nothing was applied? If someone has data on these patients, please identify them to me.

Norman

Norman McSwain Jr, MD FACS
Trauma Director Charity Hospital
Professor of Surgery
Tulane University School of Medicine
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of William Bromberg
Sent: Wednesday, October 29, 2008 12:50 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Fwd: Pelvic fractures

<snip>I don't use any of them. If they don't work, why waste the
patients
money. If they work, then the manufactures should be willing to study
them. I have asked all of them if they plan good comparative studies.
Uniform answer "No" 
Typed by the thumbs of
Norman on his BlackBerry 

Norman McSwain, MD
Tulane Univ Surgery
504 988-5111 </snip>

Dr McSwain, what do you want them to compare to? Compared to each other
— they do the same thing, pick the one that's cheapest/easiest to use.
Compared to a bed sheet --They do the same thing — but they are SO
much easier (and less likely to loosen up) that many people think it's
worth it. As to comparing them to emergent ex. fix. I don't think
funding is the difficult part of that study, it's getting the orthopods
to come in (and the problems with emergent consent).

Is it that you don't believe that the concept (closing the pelvic
volume) is sound  at all or do you go right to ex. fix?

Bill Bromberg
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Fwd: Pelvic fractures