Role of pelvic packing in the first attention given to hemodynamically unstable pelvic fracture patients: a meta-analysis

PURPOSE: To evaluate the effectiveness of pelvic packing (PP) in pelvic fracture patients with hemodynamic instability. MATERIALS AND METHODS: Three databases—PubMed, Embase and the Cochrane Library—were systematically searched to identify studies presenting comparisons between a protocol including PP and a protocol without PP. Mortality, transfusion requirement and length of hospitalization were extracted and pooled for meta-analysis. Relative risk (RR) and standard mean difference (SMD), along with their confidence intervals (CIs), were used as the pooled statistical indices. RESULTS: Eight studies involving 480 patients were identified as being eligible for meta-analysis. PP usage was associated with significantly reduced overall mortality (RR = 0.61, 95% CI = 0.47–0.79, p < 0.01) as well as reduced mortality within 24 h after admission (RR = 0.42, 95% CI = 0.26–0.69, p < 0.01) and due to hemorrhage (RR = 0.26, 95% CI = 0.14–0.50, p < 0.01). The usage of PP also decreased the need for pre-operative transfusion (SMD = − 0.44, 95% CI = − 0.69 to − 0.18, p < 0.01), but had no influence on total transfusion during the first 24 h after admission (SMD = 0.05, 95% CI = − 0.43–0.54, p = 0.83) and length of hospitalization (ICU stay and total stay). CONCLUSIONS: This meta-analysis indicates that a treatment protocol including PP could reduce mortality and transfusion requirement before intervention in pelvic fracture patients with hemodynamic instability vs. angiography and embolization. This latter technique could be used as a feasible and complementary technique afterwards. LEVEL OF EVIDENCE: 3.