Effectiveness of kaolin-impregnated hemostatic gauze use in preperitoneal pelvic packing for patients with pelvic fractures and hemodynamic instability: A propensity score matching analysis

Introduction We evaluated the effectiveness of kaolin-impregnated hemostatic gauze use in preperitoneal pelvic packing (PPP) for patients with hemodynamic instability due to severe pelvic fractures. Materials and methods Between May 2014 and October 2018, 53 of 75 patients who underwent PPP due to h...

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Published in:PloS one 2020-07, Vol.15 (7), p.e0236645-e0236645
Main Authors: Kim, Kwangmin, Shim, Hongjin, Jung, Pil Young, Kim, Seongyup, Choi, Young Un, Bae, Keum Seok, Lee, Jung Kuk, Jang, Ji Young, Farouk, Osama
Format: Article
Language:English
Subjects:
Bandage gauzes
Biology and Life Sciences
Care and treatment
Emergency medical care
Erythrocytes
Fractures
Gauze
Hemodynamics
Hemorrhage
Instability
Kaolin
Lactic acid
Matching
Medical imaging
Medical records
Medicine and Health Sciences
Mortality
Patient outcomes
Patients
Pelvic fractures
Red blood cells
Stability
Stability analysis
Trauma centers
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Summary:Introduction We evaluated the effectiveness of kaolin-impregnated hemostatic gauze use in preperitoneal pelvic packing (PPP) for patients with hemodynamic instability due to severe pelvic fractures. Materials and methods Between May 2014 and October 2018, 53 of 75 patients who underwent PPP due to hemodynamic instability induced by pelvic fracture were enrolled. Their medical records were prospectively collected and retrospectively analyzed. QuikClot combat gauze (hydrophilic gauze impregnated with kaolin) and general surgical tape were used in 21 patients, while general surgical tape was used in the remaining 32 patients. Results As there were differences in the characteristics of patients between the hemostatic gauze (HG) group and control group, propensity score matching (PSM) was performed to adjust for age, sex, and lactate levels. After PSM, the clinical characteristics between the two groups became similar. There were no differences in the rates of mortality and hemorrhage-induced mortality between the two groups. However, the packed red blood cell (RBC) requirement for an additional 12 hours in the HG group was significantly lower than that in the control group (4.1 ± 3.5 vs. 7.6 ± 6.1 units, p = 0.035). The lengths of intensive care unit and hospital stays tended to be shorter in the HG group than in the control group (11.6 vs. 18.5 days, p = 0.1582; 30.8 vs. 47.4 days, p = 0.1861, respectively). Conclusions The use of HG during PPP did not reduce hemorrhage-induced mortality, but did reduce the need for additional packed RBC transfusions in patients with hemodynamic instability due to severe pelvic fractures.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0236645