Effect of angioembolisation versus surgical packing on mortality in traumatic pelvic haemorrhage: A systematic review and meta-analysis
Author(s): El Muntasar A.; Toner E.; Alkhazaaleh O.A.; Arumugam D.; Shah N.; Hajibandah S.; Hajibandeh S.
Source: World Journal of Emergency Medicine; 2018; vol. 9 (no. 2); p. 85-92
Publication Date: 2018
Publication Type(s): Review
Available at World Journal of Emergency Medicine - from Europe PubMed Central - Open Access
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 randomeffects models. Results are reported as the odds ratio (OR) and 95% confi dence 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 signifi cantly 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 signi f icant di fference in mortal i ty between angioembolisation and pelvic packing in patients with traumatic pelvic haemorrhage. The current level of evidence in this context is very limited and insuffi cient to support the superiority of a treatment modality. Future research is required.Copyright © 2017 World Journal of Emergency Medicine.
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