The impact of external fixation on mortality in patients with an unstable pelvic ring fracture

Ohmori, Takao; Kitamura, Taisuke; Nishida, Takaya; Matsumoto, Toshiyuki; Tokioka, Takamitsu

doi:10.1302/0301-620x.100b2.bjj-2017-0852.r1

Cited by 11 publications

(3 citation statements)

References 34 publications

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“…For clinical decision-making, we calculated the estimates of TP, TN, FP, and FN per 1000 patients with a 5%, 10%, or 15% prevalence of pelvic fracture by using the pooled diagnostic accuracy [25][26][27][28]. Moreover, we calculated the net benefit and performed decision curve analysis [29,30].…”

Section: Assessment Of Clinical Utilitymentioning

confidence: 99%

Diagnostic accuracy of physical examination for detecting pelvic fractures among blunt trauma patients: a systematic review and meta-analysis

et al. 2020

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Background Pelvic fractures are common among blunt trauma patients, and timely and accurate diagnosis can improve patient outcomes. However, it remains unclear whether physical examinations are sufficient in this context. This study aims to perform a systematic review and meta-analysis of studies on the diagnostic accuracy and clinical utility of physical examination for pelvic fracture among blunt trauma patients. Methods Studies were identified using the MEDLINE, EMBASE, and CENTRAL databases starting from the creation of the database to January 2020. A total of 20 studies (49,043 patients with 8300 cases [16.9%] of pelvic fracture) were included in the quality assessment and meta-analysis. Two investigators extracted the data and evaluated the risk of bias in each study. The meta-analysis involved a hierarchical summary receiver operating curve (ROC) model to calculate the diagnostic accuracy of the physical exam. Subgroup analysis assessed the extent of between-study heterogeneity. Clinical utility was assessed using decision curve analysis. Results The median prevalence of pelvic fracture was 10.5% (interquartile range, 5.1–16.5). The pooled sensitivity (and corresponding 95% confidence interval) of the hierarchical summary ROC parameters was 0.859 (0.761–0.952) at a given specificity of 0.920, which was the median value among the included studies. Subgroup analysis revealed that the pooled sensitivity among patients with a Glasgow Coma Scale score ≥ 13 was 0.933 (0.847–0.998) at a given specificity of 0.920. The corresponding value for patients with scores ≤ 13 was 0.761 (0.560–0.932). For threshold probability < 0.01 with 10–15% prevalence, the net benefit of imaging tests was higher than that of physical examination. Conclusion Imaging tests should be performed in all trauma patients regardless of findings from physical examination or patients’ levels of consciousness. However, the clinical role of physical examination should be considered given the prevalence and threshold probability in each setting.

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Section: Assessment Of Clinical Utilitymentioning

confidence: 99%

Diagnostic accuracy of physical examination for detecting pelvic fractures among blunt trauma patients: a systematic review and meta-analysis

et al. 2020

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“…[16] Assessment of clinical utility For clinical decision-making, we calculated the estimates of TP, TN, FP, and FN per 1,000 patients with a 5%, 10%, or 15% prevalence of pelvic fracture by using the pooled diagnostic accuracy. [25][26][27][28] Moreover, we calculated the net bene t and performed decision curve analysis. [29,30] Net bene t refers to the difference between the bene t and weighted harm of the test calculated as [proportion of TP − proportion of FP × weighting].…”

Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

Diagnostic Accuracy of Physical Examination for Detecting Pelvic Fractures Among Blunt Trauma Patients: A Systematic Review and Meta-Analysis

Okada

Nishioka

Ohtsuru

et al. 2020

Preprint

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Background: Pelvic fractures are common among blunt trauma patients, and timely and accurate diagnosis can improve patient outcomes. However, it remains unclear whether physical examinations are sufficient in this context. This study aims to perform a systematic review and meta-analysis of studies on the diagnostic accuracy and clinical utility of physical examination for pelvic fracture among blunt trauma patients.Methods: Studies were identified using the MEDLINE, EMBASE, and CENTRAL databases starting from the creation of the database to January 2020. A total of 20 studies (49,043 patients with 8,300 cases [16.9%] of pelvic fracture) were included in the quality assessment and meta-analysis. Two investigators extracted the data and evaluated the risk of bias in each study. The meta-analysis involved a hierarchical summary receiver operating curve (ROC) model to calculate the diagnostic accuracy of the physical exam. Subgroup analysis assessed the extent of between-study heterogeneity. Clinical utility was assessed using decision curve analysis.Results: The median prevalence of pelvic fracture was 10.5% (interquartile range: 5.1–16.5). The pooled sensitivity (and corresponding 95% confidence interval) of the hierarchical summary ROC parameters was 0.859 (0.761–0.952) at a given specificity of 0.920, which was the median value among the included studies. Subgroup analysis revealed that the pooled sensitivity among patients with a Glasgow Coma Scale score ≥ 13 was 0.933 (0.847–0.998) at a given specificity of 0.920. The corresponding value for patients with scores ≤ 13 was 0.761 (0.560–0.932). For threshold probability < 0.01 with 10%–15% prevalence, the net benefit of imaging tests was higher than that of physical examination. Conclusion: Imaging tests should be performed in all trauma patients regardless of findings from physical examination or patients’ levels of consciousness. However, the clinical role of physical examination should be considered given the prevalence and threshold probability in each setting.

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“…Recent decades have witnessed increasing popularity of several methods that can stabilize a severe pelvic fracture and treat hemodynamic instability, including resuscitative balloon occlusion of the aorta (REBOA), transcatheter arterial embolization (TAE), and external fixation. [3][4][5] Although these methods have been associated with better outcomes, their efficacy remains controversial because of limited data.…”

Section: Introductionmentioning

confidence: 99%

Trends in Isolated Pelvic Fracture and 30-Day Survival during a Recent 15-Year Period: A Nationwide Study of the Japan Trauma Data Bank

et al. 2022

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BackgroundThe epidemiology and treatment of isolated pelvic fracture is not well understood in Japan. This study aimed to evaluate epidemiological trends in isolated pelvic trauma and in-hospital survival rates over 15 years. MethodsThis retrospective cohort study analyzed data from the Japan Trauma Data Bank for 2004-2018. Patients of any age with isolated pelvic fracture were grouped according to time period: 2004-2008 (Phase 1), 2009-2013 (Phase 2), and 2014-2018 (Phase 3). The main outcome was 30-day in-hospital survival rate. The data were analyzed using chisquared, Kruskal-Wallis, and Mantel-Haenszel trend tests. We analyzed changes in the main outcome over time in a multiple logistic regression analysis fitted with a generalized estimating equation, accounting for the within-cluster association. ResultsIn total, 5348 isolated pelvic fractures occurred during the study period. There was no significant between-phase difference in proportions of patients who underwent resuscitative balloon occlusion of the aorta or external fixation. The proportion of patients who underwent transcatheter arterial embolization increased year by year (p=0.003).

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The impact of external fixation on mortality in patients with an unstable pelvic ring fracture

Abstract: The use of EF to treat unstable pelvic ring fractures was associated with a significantly lower risk of death, especially in patients with severe fractures. Cite this article: 2018;100-B:233-41.

Cited by 11 publications

References 34 publications

Diagnostic accuracy of physical examination for detecting pelvic fractures among blunt trauma patients: a systematic review and meta-analysis

Diagnostic accuracy of physical examination for detecting pelvic fractures among blunt trauma patients: a systematic review and meta-analysis

Diagnostic Accuracy of Physical Examination for Detecting Pelvic Fractures Among Blunt Trauma Patients: A Systematic Review and Meta-Analysis

Trends in Isolated Pelvic Fracture and 30-Day Survival during a Recent 15-Year Period: A Nationwide Study of the Japan Trauma Data Bank

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