Background
Methods
Study designs
Data collection
Patient selection
Study endpoints
Statistical analysis
Propensity score
Results
REBOA (n = 636) | ACC (n = 267) |
P value | Missing | |
---|---|---|---|---|
Age (years) | 52.5 ± 21.2 | 56.7 ± 21.1 | 0.007 | 0 |
Gender (male) | 417/636 (66%) | 194/267 (73%) | 0.043 | 0 |
Onset year | 0 | |||
2004–2008 | 218/636 (34%) | 70/267 (26%) | ||
2009–2013 | 418/636 (66%) | 197/267 (74%) | ||
Mechanism of injury (blunt vs. penetrating) | 591/630 (94%) | 247/265 (93%) | 0.765 | 8 |
Cause of injury | 0.754 | 31 | ||
Accident | 429/618 (69%) | 187/254 (74%) | ||
Suicide | 127/618 (21%) | 44/254 (17%) | ||
Assault | 20/618 (32%) | 6/254 (2.4%) | ||
Workplace injuries | 39/618 (6.3%) | 16/254 (6.3%) | ||
Other | 1/618 (0.2%) | 1/254 (0.4%) | ||
Transport type | 0.008 | 27 | ||
Ambulance | 514/617 (83%) | 194/259(75%) | ||
Ambulance with physician | 26/617 (4.2%) | 24/259 (9.3%) | ||
Helicopter with physician | 73/617 (12%) | 40/259 (15%) | ||
Other | 4/617 (0.6%) | 1/259 (0.4%) | ||
Vital signs at prehospital | ||||
SBP | 101 (42) | 105 (40) | 0.42 | 358 |
HR | 97 (37) | 100 (43) | 0.76 | 163 |
RR | 24 (10) | 25 (10) | 0.445 | 232 |
Vital signs at emergency department | ||||
GCS value | 10(12) | 5(8) | <0.001 | 21 |
SBP | 89 (46) | 87 (45) | <0.001 | 0 |
HR | 102 (36) | 106 (52) | 0.181 | 14 |
RR | 25 (10) | 24 (15) | <0.001 | 99 |
RTS | 5.2 ± 2.0 | 4.2 ± 2.2 | <0.001 | 107 |
AIS | 0 | |||
Head (n = 382) | 3.6 ± 1.2 | 3.3 ± 1.1 | 0.101 | |
Face (n = 167) | 1.6 ± 0.7 | 1.8 ± 1.3 | 0.274 | |
Neck (n = 14) | 2.4 ± 1.3 | 1.5 ± 0.8 | 0.178 | |
Thorax (n = 593) | 3.8 ± 0.9 | 4.3 ± 1.1 | <0.001 | |
Abdomen and pelvis (n = 580) | 3.6 ± 1.1 | 3.8 ± 1.5 | 0.143 | |
Spine (n = 187) | 2.5 ± 1.1 | 2.6 ± 0.9 | 0.959 | |
Upper extremity (n = 209) | 2.0 ± 0.6 | 2.1 ± 0.6 | 0.284 | |
Lower extremity (n = 558) | 3.7 ± 1.3 | 3.7 ± 1.2 | 0.702 | |
Others (n = 39) | 1.1 ± 0.4 | 1.2 ± 0.4 | 0.701 | |
ISS | 34 (25) | 34 (20) | <0.001 | 0 |
TRISS (probability of survival) | 0.43 ± 0.36 | 0.27 ± 0.30 | <0.001 | 12 |
Prehospital treatment | ||||
Airway protection maneuver | 53/636 (8.3%) | 41/267 (15%) | 0.003 | 0 |
Intubation | 44/636 (6.9%) | 35/267 (13%) | 0.004 | 0 |
Intravenous fluid | 55/636 (8.6%) | 25/267 (9.3%) | 0.703 | 0 |
FAST | 0.013 | 29 | ||
Positive | 359/614 (59%) | 133/260(51%) | ||
Negative | 233/614 (38%) | 107/260 (41%) | ||
Not conducted | 22/614 (3.6%) | 20/260 (7.7%) | ||
Blood transfusion | 542/636 (85%) | 197/267 (74%) | <0.001 | 0 |
CPR | ||||
ERT with CPR | 71/636 (11%) | 216/267 (81%) | <0.001 | 0 |
Closed CPR | 141/636 (22%) | 92/267 (35%) | <0.001 | 0 |
Operation at initial evaluation | ||||
Craniotomy | 19/636 (3.0%) | 1/267 (0.4%) | 0.012 | 0 |
Craterization | 17/636 (2.7%) | 3/267 (1.2%) | 0.215 | 0 |
Thoracotomy | 70/636 (11%) | 160/267 (60%) | <0.001 | 0 |
Laparotomy | 301/636 (47%) | 99/267 (37%) | 0.005 | 0 |
Angiography | ||||
Chest | 29/636 (4.6%) | 7/267 (2.6%) | 0.196 | 0 |
Abdomen | 156/636 (25%) | 15/267 (5.6%) | <0.001 | 0 |
Pelvis | 151/636 (24%) | 22/267 (8.2%) | <0.001 | 0 |
TAE (all) | 153/636 (24%) | 18/267 (6.7%) | <0.001 | 0 |
REBOA (n = 636) | ACC (n = 267) |
P value | |
---|---|---|---|
Disposition at discharge | <0.001* | ||
Died (in-hospital mortality) | 405/607 (67%) | 210/233 (90%) | |
Transferred | 118/607 (19%) | 11/233 (1.8%) | |
Home | 83/607 (14%) | 12/233 (2.0%) | |
Other | 1/607 (0.1%) | 0/233 (0.0%) | |
Disposition at ED | <0.001* | ||
Died (ED mortality) | 137/625 (22%) | 130/264 (49%) | |
CU admission | 472/625 (76%) | 129/264 (49%) | |
Ward admission | 137/625 (22%) | 4/264 (1.5%) | |
Other | 5/625 (1.8%) | 1/264 (0.4%) |
REBOA (n = 152) | ACC (n = 152) | SD |
P value | Missing | |
---|---|---|---|---|---|
Age (years) | 52.8 ± 21.0 | 54.8 ± 22.1 | 0.09 | 0.421 | 0 |
Gender (male) | 111/152 (73%) | 101/152(66%) | 0.14 | 0.261 | 0 |
Mechanism of injury (blunt vs. penetrating) | 142/152 (93%) | 141/152(93%) | 0.03 | 1.000 | 0 |
Cause of injury | 0.726 | 0 | |||
Accident | 104 (68%) | 109 (72%) | 0.07 | ||
Suicide | 28 (18%) | 29 (19%) | 0.02 | ||
Assault | 6 (3.9%) | 5 (3.3%) | 0.04 | ||
Workplace injuries | 14(92%) | 9 (5.9%) | 0.13 | ||
Other | 0(0%) | 0 (0%) | 0.00 | ||
Transport type | 0.542 | 0 | |||
Ambulance | 124/152 (82%) | 123/152(81%) | 0.02 | ||
Ambulance with physician | 6/152 (3.9%) | 10/152 (6.6%) | 0.12 | ||
Helicopter with physician | 22/152 (15%) | 19/152 (13%) | 0.06 | ||
Other | 0/152 (0%) | 0/152(0%) | 0.00 | ||
Vital signs at emergency department | |||||
GCS value | 8(10) | 8(10) | 0.02 | 0.909 | 0 |
SBP | 77.5 (64) | 73.5 (64) | 0.02 | 0.421 | 0 |
HR | 108.0 (39) | 109.5(52) | 0.05 | 0.687 | 0 |
RR | 25 (10) | 24 (14) | 0.08 | 0.499 | 0 |
RTS | 4.8 ± 2.0 | 4.7 ± 2.1 | 0.631 | 0 | |
ISS | 34 (23) | 36 (20) | 0.11 | 0.341 | 0 |
TRISS (probability of survival) | 0.45 ± 0.35 | 0.39 ± 0.31 | 0.115 | 0 | |
Prehospital treatment | |||||
Airway protection maneuver | 12/152 (7.9%) | 11/152 (7.2%) | 0.03 | 1.000 | 0 |
Intubation | 9/152 (5.9%) | 13/152 (8.6%) | 0.10 | 0.508 | 0 |
Intravenous fluid | 9/152 (5.9%) | 14/152 (9.2%) | 0.13 | 0.386 | 0 |
FAST | 0.232 | 6 | |||
Positive | 91/148 (62%) | 78/150(52%) | |||
Negative | 52/148 (35%) | 64/150(43%) | |||
Not conducted | 5/148 (3.4%) | 8/150 (5.3%) | |||
Blood transfusion | 135/152 (89%) | 121/152(80%) | 0.04 | 0 | |
AIS | 0 | ||||
Head | 3.8 ± 1.3 | 3.4 ± 1.1 | 0.047 | ||
Face | 1.7 ± 0.8 | 1.3 ± 0.5 | 0.036 | ||
Neck | 1.3 ± 0.6 | 1.3 ± 0.5 | 0.846 | ||
Thorax | 3.8 ± 0.8 | 4.2 ± 0.8 | <0.001 | ||
Abdomen and pelvis | 3.5 ± 1.0 | 3.8 ± 1.4 | 0.112 | ||
Spine | 2.6 ± 0.9 | 2.6 ± 1.0 | 0.812 | ||
Upper extremity | 2.1 ± 0.7 | 2.1 ± 0.6 | 0.833 | ||
Lower extremity | 3.6 ± 1.4 | 3.6 ± 1.3 | 0.904 | ||
Other | 1.0 ± 0.0 | 1.3 ± 0.5 | 0.172 | ||
Operation at initial evaluation | |||||
Craniotomy | 3/152 (2.0%) | 0/152(0%) | 0.248 | 0 | |
Craterization | 4/152 (2.6%) | 1/152 (0.7%) | 0.371 | 0 | |
Thoracotomy | 20/152 (13%) | 92/152(61%) | <0.001 | 0 | |
Laparotomy | 79/152 (52%) | 68/152(45%) | 0.251 | 0 | |
Angiography | |||||
Chest | 2/152 (1.3%) | 5/152 (3.3%) | 0.448 | 0 | |
Abdomen | 27/152 (18%) | 10/152 (6.6%) | 0.004 | 0 | |
Pelvis | 33/152 (22%) | 15/152 (9.9%) | 0.007 | 0 | |
TAE (all) | 29/152 (19%) | 11/152 (7.2%) | 0.004 | 0 | |
CPR | |||||
ERT with CPR | 20/152 (13%) | 125/152 (82%) | <0.001 | 0 | |
Closed CPR | 33/152 (22%) | 53/152(35%) | 0.015 | 0 |
Discussion
Brief summary
Comparison with previous studies
Possible explanations and implications
Limitations
Conclusions
Key messages
-
Patients who underwent AO had a high mortality.
-
REBOA might be a favorable alternative method to ACC.