Preperitoneal packing versus Angioembolization for the initial management of hemodynamically unstable pelvic fracture – A Systematic Review and Meta-Analysis

2022 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jack M. McDonogh ◽  
Daniel P. Lewis ◽  
Seth M. Tarrant ◽  
Zsolt J. Balogh
Keyword(s):  
Systematic Review ◽  
Pelvic Fracture ◽  
Meta Analysis ◽  
Initial Management ◽  
Unstable Pelvic Fracture

scholarly journals Outcomes Following Primary Realignment Versus Suprapubic Cystostomy with Delayed Urethroplasty for Pelvic Fracture-Associated Posterior Urethral Injury: A Systematic Review with Meta-Analysis

2019 ◽  
Vol 13 (3) ◽  
pp. 113-124 ◽  
Author(s):  
Alexander Light ◽  
Tanya Gupta ◽  
Maria Dadabhoy ◽  
Allen Daniel ◽  
Madura Nandakumar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urinary Incontinence ◽  
Case Studies ◽  
Pelvic Fracture ◽  
Meta Analysis ◽  
Urethral Injury ◽  
Retrospective Case ◽  
Eligibility Criteria ◽  
High Quality Research ◽  
Suprapubic Cystostomy

Objective: Pelvic fracture can be complicated by posterior urethral injury (PUI) in up to 25% of cases. PUI can produce considerable morbidity, including urethral stricture, erectile dysfunction (ED), and urinary incontinence. Optimal management of PUI is unclear, however, the current gold standard is placement of a suprapubic cystostomy with delayed urethroplasty (SCDU) performed several months later. Another option is early primary realignment (PR) with urethral catheter, performed either open or endoscopically. Through a systematic review and meta-analysis, we aimed to compare PR and SCDU regarding stricture, ED, and urinary incontinence rates. In light of advancing endoscopic techniques, we also aimed to compare early endoscopic realignment (EER) alone with SCDU. Methods: PubMed, Medline, and Embase were searched for eligible studies comparing PR, including EER, and suprapubic cystostomy plus delayed urethroplasty from database inception until July 17th, 2018. We also reviewed reference lists from relevant articles. Study quality assessment was conducted using a modified Newcastle-Ottawa (mNOS) scale (maximum score 9). Results: From 461 identified articles, 13 studies encompassing 414 PR and 308 SCDU patients met our eligibility criteria. Twelve studies were retrospective non-randomized case studies, with 1 prospective randomized case study. Included studies were of moderately low quality (mNOS mean score: 6.0 ± 0.6). Meta-analysis demonstrated that PR and SCDU had similar stricture rates [odds ratio (OR): 2.14; 95% confidence interval (CI): 0.67-6.85; p = 0.20], similar rates of ED (OR: 1.06; 95% CI: 0.62-1.81; p = 0.84), and similar rates of urinary incontinence (OR: 0.94; 95% CI: 0.49-1.79; p = 0.86). Six studies compared EER alone (229 patients) versus SCDU (195 patients). Meta-analysis demonstrated that these modalities also had similar stricture rates (OR: 4.14; 95% CI: 0.76-22.45; p = 0.10), similar rates of ED (OR: 0.79; 95% CI: 0.41-1.54; p = 0.49), and similar rates of urinary incontinence (OR: 1.10; 95% CI: 0.48-2.53; p = 0.82). Conclusion: For PUI patients, neither PR nor EER produces superior outcomes compared to SCDU regarding stricture, ED, and urinary incontinence rates. The quality of studies in the literature, however, is very poor, with the majority of studies being non-randomized retrospective case studies with potentially high bias. Additional high-quality research, particularly prospective studies and randomized controlled trials, are needed to strengthen the evidence base.

scholarly journals Metaanálisis entre la videolaringoscopia y la laringoscopia directa en el manejo de la vía aérea difícil por parte de anestesiólogos experimentados

2018 ◽  
Vol 10 (8) ◽  
pp. 5
Author(s):  
Orreaga Zugasti Echarte
Keyword(s):  
Systematic Review ◽  
Tracheal Intubation ◽  
Difficult Airway ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Added Value ◽  
Initial Management ◽  
Revisión Sistemática ◽  
Para Determinar ◽  
First Time

En este artículo se presenta una revisión sistemática y metaanálisis para determinar si la literatura indicaba que los videolaringoscopios suponen una ventaja sobre la laringoscopia directa cuando son utilizados por anestesiólogos experimentados en el manejo de la vía aérea difícil prevista. El éxito en la intubación al primer intento fue mayor en el grupo de los videolaringoscopios. Su uso también se asoció con una significativa mejor visión de la glotis y con un menor traumatismo de la mucosa de la vía aérea. Se concluye que la videolaringoscopia es un valor añadido para el anestesiólogo experimentado, mejorando la intubación en el primer intento, la visión de la glotis y reduciendo el trauma de la mucosa, pudiendo tener un papel importante en el abordaje inicial de la vía aérea difícil prevista. ABSTRACT This article presents a systematic review and meta-analysis to ascertain if the literature indicated if videolaryngoscopy conferred an advantage when used by experienced anaesthetists managing patients with a known difficult airway. First-attempt success of tracheal intubation was higher in the videolaryngoscopy group. Use of videolaryngoscopy was also associated with a significantly better view of the glottis and with a less rate of airway mucosal trauma. Videolaryngoscopy has added value for the experienced anaesthetist, improving first-time success, the view of the glottis and reducing mucosal trauma. It could become a standard of care in the initial management of the known difficult airway.

Prompt procedures to hemodynamically unstable pelvic fracture patients.

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Kumiko Tanaka ◽  
Yosuke Matsumura ◽  
Junichi Matsumoto
Keyword(s):  
Pelvic Fracture ◽  
Time Course ◽  
Artery Embolization ◽  
Initial Management ◽  
Unstable Pelvic Fracture ◽  
Specialized Team

Backgroud: Angioembolization is a widely accepted method for an effective and useful hemostasis procedure in pelvic fracture (PF) patients. We evaluated and introduce the time course of the initial management and angiography in HU pelvic fracture patients. Methods: We retrospectively reviewed 56 PF patients who underwent IR from May 2010 to Dec 2016. We defined arrival to angiographytime (ATAT), it was recorded in all enrolled patients in which the first angiography image represented the initiation of angiography. We also evaluated total embolization time (TET) and single artery embolization time (SAET; time for artery selection, injection, embolization, and confirmation). Results: The median ATAT and TET was respectively 73 and 33 minutes. They were much faster than the previous reports. Conclusions: Our trauma IR strategy with specialized team might contribute to shorten the management time.  

scholarly journals Timing of device reimplantation and reinfection rates following cardiac implantable electronic device infection: a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029537 ◽  
Author(s):  
Derek Chew ◽  
Ranjani Somayaji ◽  
John Conly ◽  
Derek Exner ◽  
Elissa Rennert-May
Keyword(s):  
Systematic Review ◽  
Electronic Device ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Significant Heterogeneity ◽  
Inclusion Criteria ◽  
Cardiac Implantable Electronic Device ◽  
Initial Management ◽  
Device Infection ◽  
Incident Rate

ObjectivesInitial management of cardiac implantable electronic device (CIED) infection requires removal of the infected CIED system and treatment with systemic antibiotics. However, the optimal timing to device reimplantation is unknown. The aim of this study was to quantify the incidence of reinfection after initial management of CIED infection, and to assess the effect of timing to reimplantation on reinfection rates.DesignSystematic review and meta-analysis.InterventionsA systematic review and meta-analysis was performed of studies published up to February 2018. Inclusion criteria were: (a) documented CIED infection, (b) studies that reported the timing to device reimplantation and (c) studies that reported the proportion of participants with device reinfection. A meta-analysis of proportions using a random effects model was performed to estimate the pooled device reinfection rate.Primary and secondary outcome measuresThe primary outcome measure was the rate of CIED reinfection. The secondary outcome was all-cause mortality.ResultsOf the 280 screened studies, 8 met inclusion criteria with an average of 96 participants per study (range 15–220 participants). The pooled incidence rate of device reinfection was 0.45% (95% CI, 0.02% to 1.23%) per person year. A longer time to device reimplantation >72 hours was associated with a trend towards higher rates of reinfection (unadjusted incident rate ratio 4.8; 95% CI 0.9 to 24.3, p=0.06); however, the meta-regression analysis was unable to adjust for important clinical covariates. There did not appear to be a difference in reinfection rates when time to reimplantation was stratified at 1 week. Heterogeneity was moderate (I2=61%).ConclusionsThe incident rate of reinfection following initial management of CIED infection is not insignificant. Time to reimplantation may affect subsequent rates of device reinfection. Our findings are considered exploratory and significant heterogeneity limits interpretation.PROSERO registration numberCRD4201810960.

scholarly journals Systematic review with meta-analysis: prompt endoscopy as the initial management strategy for uninvestigated dyspepsia in Asia

2014 ◽  
Vol 41 (3) ◽  
pp. 239-252 ◽  
Author(s):  
S. L. Chen ◽  
K. A. Gwee ◽  
J. S. Lee ◽  
H. Miwa ◽  
H. Suzuki ◽  
...  
Keyword(s):  
Systematic Review ◽  
Management Strategy ◽  
Meta Analysis ◽  
Initial Management

scholarly journals Diagnostic Accuracy of Physical Examination for Detecting Pelvic Fractures Among Blunt Trauma Patients: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Yohei Okada ◽  
Norihiro Nishioka ◽  
Shigeru Ohtsuru ◽  
Yasushi Tsujimoto
Keyword(s):  
Systematic Review ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Blunt Trauma ◽  
Pelvic Fracture ◽  
Clinical Utility ◽  
Meta Analysis ◽  
Pelvic Fractures ◽  
Trauma Patients ◽  
Threshold Probability

Abstract Background: Pelvic fractures are common among blunt trauma patients, and timely and accurate diagnosis can improve patient outcomes. However, it remains unclear whether physical examinations are sufficient in this context. This study aims to perform a systematic review and meta-analysis of studies on the diagnostic accuracy and clinical utility of physical examination for pelvic fracture among blunt trauma patients.Methods: Studies were identified using the MEDLINE, EMBASE, and CENTRAL databases starting from the creation of the database to January 2020. A total of 20 studies (49,043 patients with 8,300 cases [16.9%] of pelvic fracture) were included in the quality assessment and meta-analysis. Two investigators extracted the data and evaluated the risk of bias in each study. The meta-analysis involved a hierarchical summary receiver operating curve (ROC) model to calculate the diagnostic accuracy of the physical exam. Subgroup analysis assessed the extent of between-study heterogeneity. Clinical utility was assessed using decision curve analysis.Results: The median prevalence of pelvic fracture was 10.5% (interquartile range: 5.1–16.5). The pooled sensitivity (and corresponding 95% confidence interval) of the hierarchical summary ROC parameters was 0.859 (0.761–0.952) at a given specificity of 0.920, which was the median value among the included studies. Subgroup analysis revealed that the pooled sensitivity among patients with a Glasgow Coma Scale score ≥ 13 was 0.933 (0.847–0.998) at a given specificity of 0.920. The corresponding value for patients with scores ≤ 13 was 0.761 (0.560–0.932). For threshold probability < 0.01 with 10%–15% prevalence, the net benefit of imaging tests was higher than that of physical examination. Conclusion: Imaging tests should be performed in all trauma patients regardless of findings from physical examination or patients’ levels of consciousness. However, the clinical role of physical examination should be considered given the prevalence and threshold probability in each setting.

Preperitoneal packing for pelvic fracture-associated hemorrhage: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma

2020 ◽  
Vol 220 (4) ◽  
pp. 873-888
Author(s):  
Nikolay Bugaev ◽  
Rishi Rattan ◽  
Michael Goodman ◽  
Kaushik Mukherjee ◽  
Bryce R.H. Robinson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pelvic Fracture ◽  
Meta Analysis ◽  
Practice Management ◽  
Management Guideline

scholarly journals Diagnostic accuracy of physical examination for detecting pelvic fractures among blunt trauma patients: a systematic review and meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yohei Okada ◽  
Norihiro Nishioka ◽  
Shigeru Ohtsuru ◽  
Yasushi Tsujimoto
Keyword(s):  
Systematic Review ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Blunt Trauma ◽  
Pelvic Fracture ◽  
Clinical Utility ◽  
Meta Analysis ◽  
Pelvic Fractures ◽  
Trauma Patients ◽  
Threshold Probability

Abstract Background Pelvic fractures are common among blunt trauma patients, and timely and accurate diagnosis can improve patient outcomes. However, it remains unclear whether physical examinations are sufficient in this context. This study aims to perform a systematic review and meta-analysis of studies on the diagnostic accuracy and clinical utility of physical examination for pelvic fracture among blunt trauma patients. Methods Studies were identified using the MEDLINE, EMBASE, and CENTRAL databases starting from the creation of the database to January 2020. A total of 20 studies (49,043 patients with 8300 cases [16.9%] of pelvic fracture) were included in the quality assessment and meta-analysis. Two investigators extracted the data and evaluated the risk of bias in each study. The meta-analysis involved a hierarchical summary receiver operating curve (ROC) model to calculate the diagnostic accuracy of the physical exam. Subgroup analysis assessed the extent of between-study heterogeneity. Clinical utility was assessed using decision curve analysis. Results The median prevalence of pelvic fracture was 10.5% (interquartile range, 5.1–16.5). The pooled sensitivity (and corresponding 95% confidence interval) of the hierarchical summary ROC parameters was 0.859 (0.761–0.952) at a given specificity of 0.920, which was the median value among the included studies. Subgroup analysis revealed that the pooled sensitivity among patients with a Glasgow Coma Scale score ≥ 13 was 0.933 (0.847–0.998) at a given specificity of 0.920. The corresponding value for patients with scores ≤ 13 was 0.761 (0.560–0.932). For threshold probability < 0.01 with 10–15% prevalence, the net benefit of imaging tests was higher than that of physical examination. Conclusion Imaging tests should be performed in all trauma patients regardless of findings from physical examination or patients’ levels of consciousness. However, the clinical role of physical examination should be considered given the prevalence and threshold probability in each setting.

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