Background: 

Patients with traumatic pelvic ring injury may present with hypotension secondary to hemorrhage. Preperitoneal pelvic packing (PPP) and angioembolization (AE) are alternative interventions for management of hypotension associated with pelvic ring injury refractory to resuscitation and circumferential compression. We hypothesized that PPP may be independently associated with increased risk of venous thromboembolism (VTE) compared with AE in patients with hypotension and pelvic ring injury.

Methods: 

Adult patients with pelvic ring injury and hypotension managed with PPP or AE were retrospectively identified in the Trauma Quality Improvement Program (TQIP) database from 2015 to 2019. Patients were matched on a propensity score for receiving PPP based on patient, injury, and treatment factors. The primary outcome was the risk of VTE after matching on the propensity score for treatment. The secondary outcomes included inpatient clinically important deep vein thrombosis, pulmonary embolism, respiratory failure, mortality, unplanned reoperation, sepsis, surgical site infection, hospital length of stay, and intensive care unit (ICU) length of stay.

Results: 

In this study, 502 patients treated with PPP and 2,439 patients treated with AE met inclusion criteria. After propensity score matching on age, smoking status, Injury Severity Score, Tile B or C pelvic ring injury, bilateral femoral fracture, serious head injury, units of plasma and platelets given within 4 hours of admission, laparotomy, and level-I trauma center facility designation, 183 patients treated with PPP and 183 patients treated with AE remained. PPP, compared with AE, was associated with a 9.8% greater absolute risk of VTE, 6.5% greater risk of clinically important deep vein thrombosis, and 4.9% greater risk of respiratory failure after propensity score matching.

Conclusions: 

PPP for the management of hypotension associated with pelvic ring injury is associated with higher rates of inpatient VTE events and sequelae compared with AE.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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腹膜前盆腔填塞治疗低血压比血管栓塞具有更大的静脉血栓栓塞风险：闭合性骨盆环损伤难治性低血压的管理

背景： 

外伤性骨盆环损伤患者可能会出现继发于出血的低血压。腹膜前骨盆填塞术 (PPP) 和血管栓塞术 (AE) 是治疗与复苏和环周加压难治性骨盆环损伤相关的低血压的替代干预措施。我们假设与低血压和骨盆环损伤患者的 AE 相比，PPP 可能与静脉血栓栓塞 (VTE) 风险增加独立相关。

方法： 

在 2015 年至 2019 年的创伤质量改进计划 (TQIP) 数据库中回顾性地确定了接受 PPP 或 AE 治疗的骨盆环损伤和低血压的成年患者。根据患者、损伤和治疗因素，根据接受 PPP 的倾向评分对患者进行匹配. 主要结果是根据治疗倾向评分匹配后的 VTE 风险。次要结果包括住院患者临床上重要的深静脉血栓形成、肺栓塞、呼吸衰竭、死亡率、计划外再次手术、败血症、手术部位感染、住院时间和重症监护病房 (ICU) 住院时间。

结果： 

在这项研究中，502 名接受 PPP 治疗的患者和 2,439 名接受 AE 治疗的患者符合纳入标准。根据年龄、吸烟状况、损伤严重程度评分、B 级或 C 级骨盆环损伤、双侧股骨骨折、严重颅脑损伤、入院后 4 小时内给予的血浆和血小板单位、剖腹手术和一级创伤中心进行倾向评分匹配后设施指定，183 名接受 PPP 治疗的患者和 183 名接受 AE 治疗的患者仍然存在。与 AE 相比，PPP 与 VTE 绝对风险高 9.8%、临床重要深静脉血栓形成风险高 6.5% 以及倾向评分匹配后呼吸衰竭风险高 4.9% 相关。

结论： 

与 AE 相比，PPP 治疗与骨盆环损伤相关的低血压与更高的住院 VTE 事件和后遗症发生率相关。

证据等级： 

预后三级。有关证据等级的完整描述，请参阅作者须知。