Effectiveness of pelvic packing in hemodynamically unstable patients with pelvic fracture: a meta-analysis

Abstract

Background Pelvic packing (PP) has been increasingly used for bleeding control in severe pelvic trauma. However, its effectiveness remains controversial. This meta-analysis was performed systematically to determine the efficiency of PP in pelvic fracture patients with hemodynamic instability. Methods Three databases, PubMed, Embase and Cochrane Library were systematically searched to identify studies presenting comparisons between protocol including PP and protocol without PP. Mortality, transfusion requirement and length of hospitalization were extracted and pooled for meta-analysis. Relative risk (RR) or standard mean difference (SMD) with their confidence interval (CI) was used for the pooled statistical indexes included mortality, transfusion requirement and length of hospitalization. Results Ten studies involving 560 patients were identified eligible for meta-analysis. A significantly reduced overall mortality (RR = 0.63, 95% CI = 0.50 to 0.79, p < 0.01) as well as reduced mortality within 24 h after admission (RR = 0.42, 95% CI = 0.27 to 0.63, p < 0.01) and due to hemorrhage (RR = 0.27, 95% CI = 0.15 to 0.49, p < 0.01) was shown by PP. The usage of PP also decreased the need for pre-operative transfusion (SMD = -0.44, 95% CI= -0.69 to -0.18, p = 0.001) but had no influence on transfusion during the first 24 h after admission (SMD = 0.04, 95% CI = -0.24 to 0.31, p = 0.215) and length of hospitalization (ICU and total stays). Conclusions This meta-analysis indicates that a treatment protocol including PP significantly reduce mortality and transfusion requirement before intervention in pelvic fracture patients with hemodynamic instability. An algorithm in which pelvic packing is performed as first-line treatment was recommended and complemented with angiography and embolization for patients with traumatic pelvic hemorrhage.