Filippo Migliorini, Federico Cocconi, Inger Schipper, Kaj Ten Duis, Ingo Marzi, Radko Komadina, Frank Hildebrand, Klaus Wendt
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Secondary outcomes included evaluating differences in the time from diagnosis to treatment, as well as the length of stay in the intensive care unit (ICU) and hospital.</p><p><strong>Methods: </strong>All clinically relevant studies comparing AE versus PPP in patients with complex pelvic fractures and haemodynamic instability were accessed. The 2020 PRISMA guidelines were followed. In September 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase, without constraint.</p><p><strong>Results: </strong>Data from 320 patients were collected (AE: 174; PPP: 146). The mean age on admission was 47.4 ± 7.2 years. The mean Injury Severity Score (ISS) on admission was 43.5 + 5.4 points. Baseline comparability was observed in ISS (P = 0.5, Table 3) and mean age (P = 0.7, Table 3). No difference was reported in mortality rate (P = 0.2) or rate of blood units transfused (P = 0.3). AE had a longer mean time to the procedure of 44.6 min compared to PPP (P = 0.04). The mean length of ICU and hospital stay were similar in both groups.</p><p><strong>Conclusion: </strong>Despite the longer mean time from admission to the procedure, no significant differences were found between AE and PPP in terms of in-hospital mortality, blood units transfused, or length of ICU, and hospital stay. These findings should be interpreted considering the limitations of the present study. High-quality comparative research is strongly warranted.</p><p><strong>Level of evidence: </strong>Level IV, meta-analysis.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":" ","pages":"1295-1304"},"PeriodicalIF":1.9000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11458644/pdf/","citationCount":"0","resultStr":"{\"title\":\"Arterial angioembolisation versus pre-peritoneal pelvic packing in haemodynamically unstable patients with complex pelvic fractures: a meta-analysis.\",\"authors\":\"Filippo Migliorini, Federico Cocconi, Inger Schipper, Kaj Ten Duis, Ingo Marzi, Radko Komadina, Frank Hildebrand, Klaus Wendt\",\"doi\":\"10.1007/s00068-023-02389-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Angioembolisation (AE) and/or pre-peritoneal pelvic packing (PPP) may be necessary for patients with complex pelvic fractures who are haemodynamically unstable. However, it remains unclear whether AE or PPP should be performed as an initial intervention and ongoing debates exist. This meta-analysis aimed to compare AE versus PPP in haemodynamically unstable patients with acute pelvic fractures. The primary outcomes of interest were to compare in-hospital mortality rate and number of blood units transfused. Secondary outcomes included evaluating differences in the time from diagnosis to treatment, as well as the length of stay in the intensive care unit (ICU) and hospital.</p><p><strong>Methods: </strong>All clinically relevant studies comparing AE versus PPP in patients with complex pelvic fractures and haemodynamic instability were accessed. The 2020 PRISMA guidelines were followed. In September 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase, without constraint.</p><p><strong>Results: </strong>Data from 320 patients were collected (AE: 174; PPP: 146). The mean age on admission was 47.4 ± 7.2 years. The mean Injury Severity Score (ISS) on admission was 43.5 + 5.4 points. Baseline comparability was observed in ISS (P = 0.5, Table 3) and mean age (P = 0.7, Table 3). No difference was reported in mortality rate (P = 0.2) or rate of blood units transfused (P = 0.3). AE had a longer mean time to the procedure of 44.6 min compared to PPP (P = 0.04). The mean length of ICU and hospital stay were similar in both groups.</p><p><strong>Conclusion: </strong>Despite the longer mean time from admission to the procedure, no significant differences were found between AE and PPP in terms of in-hospital mortality, blood units transfused, or length of ICU, and hospital stay. These findings should be interpreted considering the limitations of the present study. 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引用次数: 0
摘要
血管栓塞术(AE)和/或腹膜前盆腔填充物(PPP)对于血流动力学不稳定的复杂骨盆骨折患者可能是必要的。然而，目前尚不清楚是否应将AE或PPP作为初始干预措施，并且存在持续的争论。本荟萃分析旨在比较急性骨盆骨折血流动力学不稳定患者的AE与PPP。研究的主要结局是比较住院死亡率和输血单位数。次要结局包括评估从诊断到治疗的时间差异，以及在重症监护病房(ICU)和医院的住院时间。方法:查阅所有比较AE与PPP在复杂骨盆骨折伴血流动力学不稳定患者中的临床相关研究。遵循2020年PRISMA指南。2023年9月，无约束地访问了以下数据库:PubMed、Web of Science、谷歌Scholar和Embase。结果:共收集320例患者资料(AE: 174例;购买力平价:146)。入院时平均年龄47.4±7.2岁。入院时的平均损伤严重程度评分(ISS)为43.5 + 5.4分。在ISS (P = 0.5，表3)和平均年龄(P = 0.7，表3)中观察到基线可比性。在死亡率(P = 0.2)或输血单位率(P = 0.3)方面没有报告差异。AE比PPP平均手术时间长，为44.6 min (P = 0.04)。两组患者的平均ICU时间和住院时间相似。结论:尽管AE和PPP从入院到手术的平均时间更长，但在住院死亡率、输血单位数、ICU时间和住院时间方面，AE和PPP没有显著差异。这些发现应该考虑到本研究的局限性来解释。高质量的比较研究是非常必要的。证据等级:四级，荟萃分析。
Arterial angioembolisation versus pre-peritoneal pelvic packing in haemodynamically unstable patients with complex pelvic fractures: a meta-analysis.
Introduction: Angioembolisation (AE) and/or pre-peritoneal pelvic packing (PPP) may be necessary for patients with complex pelvic fractures who are haemodynamically unstable. However, it remains unclear whether AE or PPP should be performed as an initial intervention and ongoing debates exist. This meta-analysis aimed to compare AE versus PPP in haemodynamically unstable patients with acute pelvic fractures. The primary outcomes of interest were to compare in-hospital mortality rate and number of blood units transfused. Secondary outcomes included evaluating differences in the time from diagnosis to treatment, as well as the length of stay in the intensive care unit (ICU) and hospital.
Methods: All clinically relevant studies comparing AE versus PPP in patients with complex pelvic fractures and haemodynamic instability were accessed. The 2020 PRISMA guidelines were followed. In September 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase, without constraint.
Results: Data from 320 patients were collected (AE: 174; PPP: 146). The mean age on admission was 47.4 ± 7.2 years. The mean Injury Severity Score (ISS) on admission was 43.5 + 5.4 points. Baseline comparability was observed in ISS (P = 0.5, Table 3) and mean age (P = 0.7, Table 3). No difference was reported in mortality rate (P = 0.2) or rate of blood units transfused (P = 0.3). AE had a longer mean time to the procedure of 44.6 min compared to PPP (P = 0.04). The mean length of ICU and hospital stay were similar in both groups.
Conclusion: Despite the longer mean time from admission to the procedure, no significant differences were found between AE and PPP in terms of in-hospital mortality, blood units transfused, or length of ICU, and hospital stay. These findings should be interpreted considering the limitations of the present study. High-quality comparative research is strongly warranted.
期刊介绍：
The European Journal of Trauma and Emergency Surgery aims to open an interdisciplinary forum that allows for the scientific exchange between basic and clinical science related to pathophysiology, diagnostics and treatment of traumatized patients. The journal covers all aspects of clinical management, operative treatment and related research of traumatic injuries.
Clinical and experimental papers on issues relevant for the improvement of trauma care are published. Reviews, original articles, short communications and letters allow the appropriate presentation of major and minor topics.
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