Association Between Hemorrhage Control Interventions and Mortality in US Trauma Patients With Hemodynamically Unstable Pelvic Fractures
Authors' conclusion
This study found that among patients with pelvic fracture who received early transfusions and at least 1 invasive pelvic hemorrhage control intervention, more than 1 in 3 died, despite the availability of advanced hemorrhage control interventions. Only pelvic AE was associated with a reduction in mortality.
Study context
- Population
- Adults (≥18 years) with pelvic fractures who received early transfusions (≥4 units packed RBC in 4 hours) and underwent pelvic hemorrhage control intervention, 2017 ACS TQIP database, US
- Participants
- 774 / 659 / 126
- Exposure
- Patterns of hemorrhage control interventions: preperitoneal pelvic packing (PP), pelvic angioembolization (AE), resuscitative endovascular balloon occlusion of the aorta (REBOA) zone 3
- Pelvic AEn = 774
- Preperitoneal PPn = 659
- REBOA zone 3n = 126
- Outcome
- 24-hour, ED and in-hospital mortality
Methodological detailsnational multi-institutional database, backward stepwise regression
- National multi-institutional database
- Backward stepwise regression
Main finding
As reported in the abstract
Mortality
Odds ratio (95% CI)P value
Pelvic AEregression analysis; only pelvic AE associated with mortality reduction
0.62(0.47–0.82)
P < 0.001Increasing number of interventionsregression analysis
1.57(1.05–2.37)
P = 0.03- 24-hour mortality
- 217 (15.5%)
- ED mortality
- 10 (0.7%)
- In-hospital mortality
- 501 (36%)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | β (95% CI) | P value |
|---|---|---|
| 24-hour transfusions | +5.4 (+3.5 to +7.5) | P < 0.001 |
Number of interventions
- 1 intervention
- 1236 (89%)
- 2 interventions
- 157 (11%)
- 3 interventions
- 3 (0.2%)
Safety
Major in-hospital complications
| OR (95% CI) | P value | ||
|---|---|---|---|
| Preperitoneal PP | 1.39 (1.07–1.80) | P = 0.01 | |
| 0.512Odds ratio (log scale) |
- Major in-hospital complications — Complication rate, overall
- 574 (41%)
Major in-hospital complications
- Increasing number of interventions not associated with complications
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Association Between Hemorrhage Control Interventions and Mortality in US Trauma Patients With Hemodynamically Unstable Pelvic Fractures. JAMA Surg. Published 1 January 2023. doi:10.
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