The Role for Preperitoneal Pelvic Packing in Low-to-Middle-Income Countries: A 16-Year Experience at a Johannesburg Trauma Unit,World Journal of Surgery

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The Role for Preperitoneal Pelvic Packing in Low-to-Middle-Income Countries: A 16-Year Experience at a Johannesburg Trauma Unit
World Journal of Surgery ( IF 2.3 ) Pub Date : 2023-09-17 , DOI: 10.1007/s00268-023-07173-4
Maeyane Stephens Moeng ₁ , Francois Viljoen ₁ , Shumani Makhadi ₁

Affiliation

Introduction

Preperitoneal pelvic packing for early pelvic haemorrhage control reduces mortality. Bleeding noted with pelvis fractures is predominantly due to associated venous complex injuries. More studies are advocating for angiography as first-line therapy for haemodynamic instability in pelvic fractures; however, these facilities are not in abundance in middle- and low-income countries. We hypothesized that PPP improves outcomes under these circumstances.

Methods

Retrospective analysis of data from the patients charts over a period of 16 years from 01 January, 2005 to 31 December, 2020. All patients over the age of 18 years who presented with haemodynamic instability from a pelvic fracture and required PPP were included. The demographics, physiological parameter in emergency department, blood products transfused, morbidity and mortality were analysed.

Results

There were 110 patients identified in the study period who underwent pelvic preperitoneal packing for refractory shock or ongoing bleeding. The majority (75.5%) of patients were men (n = 83). The median age was 38 years. The most common mechanism of injury was pedestrian vehicle collision (51%), followed by motor vehicle collisions (27.3%). The median ISS and NISS were 35 and 40, respectively. The median RTS in ED was 4.8(3–6.8). None of our patients rebleed after pack removal and no one needed repacking or adjunct angioembolization in our study group. The in-hospital mortality rate was 43.6% (n = 48) in patients who underwent preperitoneal pelvic packing. The operating room table mortality was 20% (n = 22/110), and the mortality rate of those who survived to ICU transfer was 29.5% (n = 26/88).

Conclusions

Pelvic preperitoneal packing has a role in the acute management of haemodynamically abnormal patients with pelvic fractures in our environment. In the absence of immediate angioembolization, preperitoneal packing can be lifesaving.

中文翻译：

腹膜前骨盆填塞在中低收入国家的作用：约翰内斯堡创伤科 16 年的经验

介绍

腹膜前盆腔填塞用于早期盆腔出血控制可降低死亡率。骨盆骨折引起的出血主要是由于相关的静脉复合体损伤所致。更多的研究提倡将血管造影作为骨盆骨折血流动力学不稳定的一线治疗方法；然而，中等收入和低收入国家的这些设施并不丰富。我们假设 PPP 可以改善这些情况下的结果。

方法

对2005年1月1日至2020年12月31日16年间的患者图表数据进行回顾性分析。所有年龄超过18岁、因骨盆骨折而出现血流动力学不稳定且需要进行PPP的患者均被纳入。分析人口统计学、急诊科生理参数、输注血液制品、发病率和死亡率。

结果

研究期间确定了 110 名因顽固性休克或持续出血而接受盆腔腹膜前填塞的患者。大多数 (75.5%) 患者是男性 ( n = 83)。中位年龄为 38 岁。最常见的伤害机制是行人车辆碰撞（51%），其次是机动车碰撞（27.3%）。ISS 和 NISS 中位数分别为 35 和 40。ED 中的 RTS 中位数为 4.8（3-6.8）。在我们的研究组中，没有任何患者在取出包裹后再出血，也没有人需要重新包裹或辅助血管栓塞术。接受腹膜前盆腔填塞的患者院内死亡率为 43.6%（n = 48）。手术室台死亡率为20%（n =22/110），转ICU存活者死亡率为29.5%（n= 26/88）。