From the Department of Traumatology (J.M.M., D.P.L., S.M.T., Z.J.B.), John Hunter Hospital, Newcastle, NSW, Australia; and University of Newcastle (S.M.T., Z.J.B.), Newcastle, NSW, Australia.
J Trauma Acute Care Surg. 2022 May 1;92(5):931-939. doi: 10.1097/TA.0000000000003528. Epub 2022 Jan 5.
Hemodynamically unstable pelvic fracture patients are challenging to manage. Preperitoneal packing (PPP) and angioembolization (AE) are two interventions commonly used to help gain hemorrhage control. Recently, there has been a tendency to support PPP in hemodynamically unstable pelvic fracture seemingly in direct comparison with AE. However, it seems that key differences between published cohorts exist that limits a comparison between these two modalities.
A systematic literature search of the MEDLINE, CINAHL, and EMBASE databases was conducted. Prospective and retrospective studies were eligible. No limitation was placed on publication date, with only manuscripts printed in English eligible (PROSPERO CRD42021236219). Included studies were retrospective and prospective cohort studies and a quasirandomized control trial. Studies reported demographic and outcome data on hemodynamically unstable patients with pelvis fractures that had either PPP or AE as their initial hemorrhage control intervention. The primary outcome was in-hospital mortality rate. Eighteen studies were included totaling 579 patients, of which 402 were treated with PPP and 177 with AE.
Significant differences were found between AE and PPP in regard to age, presence of arterial hemorrhage, Injury Severity Score, and time to intervention. The crude mortality rate for PPP was 23%, and for AE, it was 32% (p = 0.001). Analysis of dual-arm studies showed no significant difference in mortality. Interestingly, 27% of patients treated with PPP did not get adequate hemorrhage control and required subsequent AE.
Because of bias, heterogeneity, and inadequate reporting of physiological data, a conclusive comparison between modalities is impossible. In addition, in more than a quarter of the cases treated with PPP, the patients did not achieve hemorrhage control until subsequent AE was performed. This systematic review highlights the need for standardized reporting in this high-risk group of trauma patients.
Systematic review and meta-analysis, level III.
血流动力学不稳定的骨盆骨折患者较难处理。经腹膜前填塞（PPP）和血管栓塞（AE）是两种常用于帮助控制出血的干预措施。最近，似乎有一种倾向是支持在血流动力学不稳定的骨盆骨折中使用 PPP，似乎与 AE 直接比较。然而，似乎在已发表的队列之间存在关键差异，限制了这两种方式之间的比较。
对 MEDLINE、CINAHL 和 EMBASE 数据库进行了系统的文献检索。纳入了前瞻性和回顾性研究。没有对发表日期进行限制，只有英文印刷的手稿符合条件（PROSPERO CRD42021236219）。纳入的研究是回顾性和前瞻性队列研究以及准随机对照试验。研究报告了血流动力学不稳定的骨盆骨折患者的人口统计学和结果数据，这些患者最初的出血控制干预措施是 PPP 或 AE。主要结局是院内死亡率。共纳入 18 项研究，总计 579 例患者，其中 402 例接受 PPP 治疗，177 例接受 AE 治疗。
在年龄、动脉出血、损伤严重程度评分和干预时间方面，AE 和 PPP 之间存在显著差异。PPP 的粗死亡率为 23%，AE 为 32%（p=0.001）。对双臂研究的分析显示死亡率无显著差异。有趣的是，27%接受 PPP 治疗的患者未得到充分的出血控制，需要随后进行 AE。
由于存在偏见、异质性和生理数据报告不充分，因此不可能对两种方式进行结论性比较。此外，在接受 PPP 治疗的病例中，超过四分之一的病例直到随后进行 AE 才实现出血控制。本系统评价强调了在这一高危创伤患者群体中需要进行标准化报告。
系统评价和荟萃分析，III 级。
