Preperitoneal pelvic packing for initial management of hemodynamically unstable pelvic fracture: a systematic review and meta-analysis
- Author:
Junhyuk CHOI
1
;
Minseo CHOI
;
Sohee JI
;
Yoonsuh CHO
;
Myung Ha KIM
;
Jae Sik CHUNG
;
Young-Il ROH
;
Jae Hung JUNG
;
In Sik SHIN
;
Kwangmin KIM
Author Information
1. Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Publication Type:Original Article
- From:Journal of the Korean Society of Emergency Medicine
2024;35(4):275-300
- CountryRepublic of Korea
- Language:English
-
Abstract:
Objective:This study compared the effects of preperitoneal pelvic packing (PPP) versus resuscitation alone, angioembolization, PPP with pelvic stabilization, resuscitative endovascular balloon occlusion of the aorta (REBOA) with PPP, pelvic stabilization, and REBOA.
Methods:A comprehensive search was performed using multiple databases, trial registries, grey literature, and conference proceedings from inception until March 10, 2022. The risk of bias in non-randomized studies of intervention (ROBINS-I) and ROB 2.0 tools were used to assess the risk of bias for non-randomized studies and randomized controlled trials, respectively. The certainty of evidence was rated using the GRADE approach.
Results:Twenty-two studies, including 1,762 participants, were retrieved. Based on randomized controlled trials, there was a high uncertainty regarding the effects of PPP versus angioembolization on improving the mortality rate (risk ratio [RR]=0.74; 95% confidence interval [CI] 0.22-2.49; very low certainty of evidence) and improving the hemorrhagic mortality rate (RR=0.19; 95% CI 0.01-3.72; very low certainty of evidence). Based on non-randomized studies, there was a high uncertainty regarding the effects of PPP versus angioembolization on improving the mortality rate (RR=0.76; 95% CI 0.48-1.21; I2=54%; very low certainty of evidence), improving the hemorrhagic mortality rate (RR=0.66; 95% CI 0.18-2.46; I2=75%; very low certainty of evidence), and reducing the post procedural complications (RR=0.76; 95% CI 0.39-1.48; I2=66%; very low certainty of evidence).
Conclusion:There is high uncertainty regarding the effects of PPP compared to resuscitation only, angioembolization, PPP with pelvic stabilization, REBOA following PPP, pelvic stabilization, and REBOA. (Registration No. CRD42022311628)
