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J Korean Soc Emerg Med > Volume 35(4); 2024 > Article
Journal of The Korean Society of Emergency Medicine 2024;35(4): 275-300.
Preperitoneal pelvic packing for initial management of hemodynamically unstable pelvic fracture: a systematic review and meta-analysis
Junhyuk Choi1 , Minseo Choi2 , Sohee Ji2 , Yoonsuh Cho2 , Myung Ha Kim3 , Jae Sik Chung4 , Young-Il Roh1 , Jae Hung Jung5,6 , In Sik Shin7 , Kwangmin Kim6,8
1Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
2Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
3Yonsei Wonju Medical Library, Yonsei KoreaUniversity Wonju College of Medicine, Wonju, Korea
4Trauma Center, Wonju Severance Christian Hospital, Wonju, Korea
5Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
6Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea
7Department of Acute Care Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
8Health Check-up Center, Wonju Severance Christian Hospital, Wonju, Korea
Correspondence  Kwangmin Kim ,Tel: 033-741-0570, Fax: 033-741-0574, Email: lukelike@yonsei.ac.kr,
Received: August 7, 2023; Revised: September 12, 2023   Accepted: September 18, 2023.  Published online: August 30, 2024.
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.
Method:
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)
Key words: Pelvic fracture; Pelvic trauma; Hemodynamic instability; Preperitoneal packing
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