18 | wetenschapsdag 2023 x Lopend onderzoek in de regio Amsterdam Auteurs A.H.M. Mennen, M. Lommerse, R. Hemke, H.C. Willems, K.J. Ponsen, M. Maas, F.W. Bloemers, D. van Embden; PELVIC study group Abstract title Impact of regional implementation of a clinical pathway for elderly patients with pelvic fragility fractures (PELVIC) after low energy trauma; a multicentre, stepped-wedge, randomized controlled trial Introduction Patients with pelvic fragility fractures suffer from high morbidity and mortality rates. Despite the high incidence of these injuries, there is currently no regional or nationwide treatment protocol which results in a wide variety of clinical practice. New insights in treatment strategies, such as early diagnosis and minimal invasive operative treatment of these fragile patient population, has led to the development of several clinical pathways in recent literature. The aim of this study is to implement an evidence and experience-based treatment clinical pathway to improve the outcomes in this fragile patient population that currently has multifactorial risks for poor outcome Methods and analysis This study will be a regional stepped-wedge cluster RCT which aims for implementation of a clinical pathway in nine trauma centres in the Netherlands. All elderly patients (≥ 50 years old) who suffered a pelvic fragility fracture after low energetic trauma (LET) and are presented to one of the participating hospitals are eligible for inclusion. The pathway aims to optimise the diagnostic process, guides the decision making process for further treatment (e.g. operative or conservative), structures the follow-up, and provides guidelines on post-operative care, pain management, a physiotherapy protocol, and osteoporosis work-up. Outcome measurements The primary outcome is mobility, measured by the Parker Mobility Score (PMS). Secondary outcomes are mobility measured by the Elderly Mobility Scale (EMS), functional performance, quality of life, return to home rate, level of pain, type and dosage of analgesic medications, number of falls after treatment, number of (fracture related) complications, 1-year and 2-year mortality. Every 6 weeks a cluster will switch from current practice to the clinical pathway. The aim is a total of 393 inclusions, which provides a 80% statistical power for an improvement in mobility of 10%, measured by the Parker mobility score (PMS). 2
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