Effect of angioembolisation versus surgical packing on mortality in traumatic pelvic haemorrhage: A systematic review and meta-analysis

doi:10.5847/wjem.j.1920-8642.2018.02.001

Abstract

Abstract:

BACKGROUND: The management of complex pattern of bleeding associated with pelvic trauma remains a big challenge for trauma surgeons. We aimed to conduct a comprehensive meta-analysis to compare the outcomes of angioembolisation and pelvic packing in patients with pelvic trauma.
METHODS: We conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the CENTRAL; the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. The primary outcome was defined as mortality. Combined overall effect sizes were calculated using random-effects models. Results are reported as the odds ratio (OR) and 95% confidence interval (CI).
RESULTS: We identified 3 observational studies reporting a total of 120 patients undergoing angioembolisation (n=60) or pelvic packing (n=60) for pelvic trauma. Reporting of the Injury Severity Score (ISS) was variable, with higher ISS in the pelvic packing group. The risk of bias was low in two studies, and moderate in one. The pooled analysis demonstrated that angioembolisation did not significantly reduce mortality in patients with pelvic trauma compared to surgery (OR=1.99; 95% CI= 0.83-4.78, P=0.12). There was mild between-study heterogeneity (I²=0%, P=0.65).
CONCLUSION: Our analysis found no significant difference in mortality between angioembolisation and pelvic packing in patients with traumatic pelvic haemorrhage. The current level of evidence in this context is very limited and insufficient to support the superiority of a treatment modality. Future research is required.

Key words: Pelvic trauma, Pelvic packing, Angiography, Embolisation

Ahmed El Muntasar, Ethan Toner, Oddai A. Alkhazaaleh, Danaradja Arumugam, Nikhil Shah, Shahab Hajibandeh, Shahin Hajibandeh. Effect of angioembolisation versus surgical packing on mortality in traumatic pelvic haemorrhage: A systematic review and meta-analysis[J]. World Journal of Emergency Medicine, 2018, 9(2): 85-92.

Figures/Tables 6

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Figure 1.

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Figure 2.

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Search no.	Search strategy
#1	Pelvic injury
#2	Abdominopelvic trauma
#3	Pelvic trauma
#4	#1 OR #2 OR #3
#5	Pelvic packing
#6	Surgical packing
#7	Surgery
#8	Trauma surgery
#9	#5 or #6 or #7 or #8
#10	Embolisation
#11	Embolization
#12	Angio
#13	#10 OR #11 OR #12
#14	#4 AND #9 AND #13

Author	Year	Country	Journal	Type of study
Tai et al^[14]	2011	China	J Trauma Inj Infect Crit Care	Retrospective observational study
Osborn et al^[15]	2009	USA	Injury	Retrospective observational study
Li et al^[16]	2016	China	Injury	Retrospective observational study

Author	Number of patients	AE	Packing	Mean age^a	Haemodynamic status	ISS^a	Major fracture^b	Minor fracture^c
Tai et al^[14]	24	13	11	44.8±24.7 vs. 51.2±19 P=0.490	Unstable	42.3±18.8 vs. 40±12.5 P=0.732	72.7% vs. 53.9%	27.3% vs. 46.1%
Osborn et al^[15]	40	20	20	39.5±17.4 vs. 37.9±18.9 P=NS	Unstable	45.9±8.7 vs. 54.7±12.7 P=0.014	70.0% vs. 65.0%	30.0% vs. 35.0%
Li et al^[16]	56	27	29	43±13 vs. 40±9 P=0.373	Unstable	48±6 vs. 43±7 P=0.005	All patients	NA

Author	Representativeness of the exposed cohort	Selection of the non-exposed cohort	Ascertainment of exposure	Demonstration that outcome of interest was not present at start of study	Comparability of cohorts on the basis of the design or analysis	Assessment of outcome	Was follow-up long enough for outcomes to occur	Adequacy of follow up of cohorts	Total score
Tai et al^[14]	*	*	*	*	*	*	*	*	9
Osborn et al^[15]	*	*	*	*	*	*	*	*	8
Li et al^[16]	*	*	*	*	*	*	*	*	9

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