高位钝性外伤脾损伤的预防性栓塞与观察:系统回顾与荟萃分析。

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES
Silas Nann, Molly Clark, Joshua Kovoor, Shivangi Jog, Edoardo Aromataris
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引用次数: 0

摘要

目的:本系统综述的目的是比较预防性血管栓塞术和观察法作为主要治疗策略对高级别(3-5 级)钝性创伤脾损伤患者的有效性:简介:脾脏经常在腹部创伤中受伤。导言:腹部创伤时脾脏经常受伤,以往的处理方法包括脾脏切除术,但最近的证据表明这种方法会增加严重感染和败血症的风险。因此,包括预防性脾动脉栓塞和临床观察在内的非手术治疗策略越来越受到重视。本系统性综述与荟萃分析直接比较了血管栓塞术与临床观察对高位脾损伤的治疗效果,目的是在临床实践中不断争论和变化的情况下澄清这一问题:本综述包括年龄在 15 岁或 15 岁以上、因钝性外伤导致高级别的脾损伤(3-5 级)的成年患者。相关结果包括需要进一步干预(治疗失败)、死亡率、并发症、红细胞输血需求、住院时间和重症监护室住院时间:对 PubMed、Embase 和 CINAHL(EBSCOhost)进行了全面检索,对语言和出版日期没有限制。还检索了灰色文献,包括试验登记和相关会议论文集。经过重复筛选后,由两名审稿人独立评估标题和摘要,随后评估文章全文是否合格。采用 JBI 提供的标准化工具对纳入研究的方法学质量进行评估。使用预定义模板提取数据,并尽可能使用随机效应模型进行统计荟萃分析。使用统计方法评估异质性,并使用漏斗图检测潜在的发表偏倚。采用建议、评估、发展和评价分级法(GRADE)评估证据的确定性:本综述共纳入 16 项研究。方法学质量评估表明,大多数研究存在一定的偏倚风险,主要与损伤严重程度差异和潜在混杂因素有关。Meta 分析显示,与单纯临床观察相比,预防性血管栓塞术可将治疗失败的风险显著降低 57%(OR 0.43,95% CI 0.28-0.68,I2=53%,15 项研究),并将患者死亡率降低 37%(OR 0.63,95% CI 0.43-0.93,I2=0%,9 项研究)。与临床观察相比,预防性栓塞的相关并发症风险降低了 47%(OR 0.53,95% CI 0.29-0.95,I2=0%,4 项研究)。观察到一些统计异质性,I2范围在0%到53%之间。两种管理策略在红细胞输注需求和住院时间方面无明显差异:这项研究的结果表明,预防性栓塞治疗高位钝性创伤脾损伤的失败率较低,减少了额外干预的需要,降低了死亡率,减少了并发症,因此支持使用预防性栓塞治疗高位钝性创伤脾损伤:ProCORMBERCO CRD42023420220。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prophylactic embolization versus observation for high-grade blunt trauma splenic injury: a systematic review with meta-analysis.

Objective: The objective of this systematic review was to compare the effectiveness of prophylactic angioembolization with observation as primary management strategies for patients with high-grade (grades 3-5) blunt trauma splenic injury.

Introduction: The spleen is frequently injured in abdominal trauma. Historical management practices involved splenectomy, but more recent evidence suggests an increased risk of severe infections and sepsis associated with this approach. Accordingly, non-operative management strategies, including prophylactic splenic artery embolization and clinical observation, have gained prominence. This systematic review with meta-analysis directly compares angioembolization with clinical observation for high-grade splenic injuries only, aiming to provide clarity on this matter amid ongoing debates and variations in clinical practice.

Inclusion criteria: This review included adult patients aged 15 years or older with high-grade splenic injuries (grade 3-5) due to blunt trauma. Outcomes of interest include the need for further intervention (failure of management), mortality, complications, red blood cell transfusion requirements, hospital length of stay, and intensive care unit length of stay.

Methods: A comprehensive search of PubMed, Embase, and CINAHL (EBSCOhost), was performed with no restrictions on language or publication date. Gray literature was searched, including trial registries and relevant conference proceedings. After deduplication, 2 reviewers independently assessed titles and abstracts, and, subsequently, full-text articles for eligibility. Methodological quality of the included studies was assessed using standardized instruments from JBI. Data was extracted using predefined templates, and statistical meta-analysis was performed, where possible, using a random effects model. Heterogeneity was assessed using statistical methods, and potential publication bias was tested with a funnel plot. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the certainty of evidence.

Results: Sixteen studies were included in this review. Methodological quality assessment indicated some risk of bias in most studies, with concerns primarily related to differences in injury severity and potential confounding factors. Meta-analysis revealed that prophylactic angioembolization significantly reduced risk of management failure by 57% (OR 0.43, 95% CI 0.28-0.68, I2=53%, 15 studies) and decreased patient mortality by 37% (OR 0.63, 95% CI 0.43-0.93, I2=0%, 9 studies) compared with clinical observation alone. There was a 47% reduction in risk of complications associated with prophylactic embolization compared with clinical observation (OR 0.53, 95% CI 0.29-0.95, I2=0%, 4 studies). Some statistical heterogeneity was observed, with I2 ranging from 0% to 53%. No significant differences were observed between the 2 management strategies for red blood cell transfusion requirements and hospital length of stay.

Conclusions: The results of this study support the use of prophylactic embolization for high-grade blunt trauma splenic injuries, indicated by lower failure of management rates, reduced need for additional interventions, lower mortality, and fewer complications.

Review registration: PROSPERO CRD42023420220.

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来源期刊
JBI evidence synthesis
JBI evidence synthesis Nursing-Nursing (all)
CiteScore
4.50
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3.70%
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218
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