Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama-shi, Kanagawa, 230-0012, Japan.
Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama, 330-8503, Japan.
World J Surg. 2020 Jul;44(7):2229-2236. doi: 10.1007/s00268-020-05441-1.
Hemorrhage control for pelvic fractures remains challenging. There are several kinds of hemostatic interventions, including angiography/angioembolization (AG/AE), external fixation (EF), and resuscitative endovascular balloon occlusion of the aorta (REBOA). However, no large studies have been conducted for the comparative review of each intervention. In this study, we examined the usage trend of therapeutic interventions in Japan for patients with pelvic fractures in shock and the influence of these interventions on mortality.
Data of adult patients with pelvic fracture who were in shock were obtained from the Japanese Trauma Data Bank (2004-2014). The primary endpoint was the influence of each intervention (AG/AE, EF, and REBOA) on in-hospital mortality. We also investigated the frequency of each intervention.
A total of 3149 patients met all our inclusion criteria. Specifically, 1131 (35.9%), 496 (15.8%), and 256 (8.1%) patients underwent AG, EF, and REBOA interventions, respectively. Therapeutic AE was performed in 690 patients who underwent AG (61.0%). The overall mortality rate was 31.4%. Multiple regression analysis identified that AG/AE (OR 0.64, 95% CI 0.52-0.80) and EF (OR 0.75, 95% CI 0.58-0.98) were significantly associated with survival, whereas REBOA (OR 4.17, 95% CI 3.00-5.82) was significantly associated with worse outcomes.
In Japan, patients with pelvic fracture who were in shock had high mortality rates. AG/AE and EF were associated with decreased mortality. AG may benefit from the early detection of arterial bleeding, leading to decreased mortality of patients with pelvic fracture in shock.
骨盆骨折的出血控制仍然具有挑战性。有几种止血干预措施，包括血管造影/血管栓塞（AG/AE）、外固定（EF）和复苏性主动脉内球囊闭塞（REBOA）。然而，目前还没有进行大规模的研究来对每种干预措施进行比较评价。在这项研究中，我们检查了日本对休克骨盆骨折患者治疗干预措施的使用趋势，以及这些干预措施对死亡率的影响。
从日本创伤数据库（2004-2014 年）中获取了休克骨盆骨折成年患者的数据。主要终点是每种干预措施（AG/AE、EF 和 REBOA）对院内死亡率的影响。我们还调查了每种干预措施的频率。
共有 3149 名符合所有纳入标准的患者。具体来说，分别有 1131（35.9%）、496（15.8%）和 256（8.1%）名患者接受了 AG、EF 和 REBOA 干预，分别有 690 名接受 AG 的患者进行了治疗性 AE（61.0%）。总体死亡率为 31.4%。多变量回归分析确定，AG/AE（OR 0.64，95%CI 0.52-0.80）和 EF（OR 0.75，95%CI 0.58-0.98）与生存显著相关，而 REBOA（OR 4.17，95%CI 3.00-5.82）与较差的结果显著相关。
在日本，休克骨盆骨折患者的死亡率较高。AG/AE 和 EF 与死亡率降低相关。AG 可能受益于早期发现动脉出血，从而降低休克骨盆骨折患者的死亡率。
