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Effectiveness and Usage Trends of Hemorrhage Control Interventions in Patients with Pelvic Fracture in Shock

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Abstract

Background

Hemorrhage control for pelvic fractures remains challenging. There are several kinds of hemostatic interventions, including angiography/angioembolization (AG/AE), external fixation (EF), and resuscitative endovascular balloon occlusion of the aorta (REBOA). However, no large studies have been conducted for the comparative review of each intervention. In this study, we examined the usage trend of therapeutic interventions in Japan for patients with pelvic fractures in shock and the influence of these interventions on mortality.

Methods

Data of adult patients with pelvic fracture who were in shock were obtained from the Japanese Trauma Data Bank (2004–2014). The primary endpoint was the influence of each intervention (AG/AE, EF, and REBOA) on in-hospital mortality. We also investigated the frequency of each intervention.

Results

A total of 3149 patients met all our inclusion criteria. Specifically, 1131 (35.9%), 496 (15.8%), and 256 (8.1%) patients underwent AG, EF, and REBOA interventions, respectively. Therapeutic AE was performed in 690 patients who underwent AG (61.0%). The overall mortality rate was 31.4%. Multiple regression analysis identified that AG/AE (OR 0.64, 95% CI 0.52–0.80) and EF (OR 0.75, 95% CI 0.58–0.98) were significantly associated with survival, whereas REBOA (OR 4.17, 95% CI 3.00–5.82) was significantly associated with worse outcomes.

Conclusions

In Japan, patients with pelvic fracture who were in shock had high mortality rates. AG/AE and EF were associated with decreased mortality. AG may benefit from the early detection of arterial bleeding, leading to decreased mortality of patients with pelvic fracture in shock.

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Acknowledgements

The authors gratefully acknowledge the assistance of Yayoi Miura from the Office of Research Administration at the Saiseikai Yokohamashi Tobu Hospital in drafting and critically editing of this manuscript.

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Authors and Affiliations

  1. Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama-shi, Kanagawa, 230-0012, Japan

    Shokei Matsumoto, Tomohiro Funabiki & Motoyasu Yamazaki

  2. Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama, 330-8503, Japan

    Shokei Matsumoto, Takayuki Ebihara & Takashi Moriya

  3. Department of Emergency Medicine, Feinstein Institutes for Medical Research, Northwell Health System, 350 Community Dr, Manhasset, NY, 11030, USA

    Kei Hayashida

Authors
  1. Shokei Matsumoto
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  2. Tomohiro Funabiki
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  3. Kei Hayashida
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  4. Motoyasu Yamazaki
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  5. Takayuki Ebihara
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  6. Takashi Moriya
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Contributions

SM participated in the study design, drafting of the article, and analysis and interpretation of data. KH participated in statistical analysis. TF and TM participated in the study design and drafting of the article. MY and TE  participated in the study design.

Corresponding author

Correspondence to Shokei Matsumoto.

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Compliance with ethical standards

This retrospective study was approved by the institutional review board of each hospital.

Conflict of interest

The authors declare that they have no conflict of interest.

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Online Appendix 1

Intervention use according to the severity of pelvic fracture (TIFF 5776 kb)

Online Appendix 2

Trend management and outcomes in patients with pelvic fracture in shock (*) p < 0.05 (TIFF 5776 kb)

Supplementary material 3 (DOCX 19 kb)

Supplementary material 4 (DOCX 25 kb)

Supplementary material 5 (DOCX 17 kb)

Supplementary material 6 (DOCX 20 kb)

Supplementary material 7 (DOCX 19 kb)

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Matsumoto, S., Funabiki, T., Hayashida, K. et al. Effectiveness and Usage Trends of Hemorrhage Control Interventions in Patients with Pelvic Fracture in Shock. World J Surg 44, 2229–2236 (2020). https://doi.org/10.1007/s00268-020-05441-1

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  • DOI: https://doi.org/10.1007/s00268-020-05441-1

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