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

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Ahmed El Muntasar1, Ethan Toner1, Oddai A. Alkhazaaleh1, Danaradja Arumugam1, Nikhil Shah2, Shahab Hajibandeh3, Shahin Hajibandeh4

 

1 Department of General Surgery, Royal Blackburn Hospital, Blackburn, UK

 

2 Department of Trauma and Orthopaedics, Wrightington, Wigan and Leigh NHS Foundation Trust, UK

 

3 Department of General Surgery, Salford Royal Hospital, Salford, UK

 

4 Department of General Surgery, North Manchester General Hospital, Manchester, UK

 

Corresponding Author: Shahin Hajibandeh, Email: shahin_hajibandeh@yahoo.com

 

© 2018 World Journal of Emergency Medicine

 

DOI: 10.5847/wjem.j.1920–8642.2018.02.001

 

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 randomeffects 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.

(World J Emerg Med 2018;9(2):85–92)

 

KEY WORDS: Pelvic trauma; Pelvic packing; Angiography; Embolisation

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