Infectious complications of extra-peritoneal pelvic packing in emergency room.

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Surgical Critical Care

Background:

• Extra-Peritoneal Pelvic Packing (EPP) is a critical intervention for managing severe pelvic hemorrhage.
• Performing EPP in the Emergency Room (ER) may pose infection risks due to a less sterile environment compared to the Operating Room (OR).

Purpose of the Study:

• To compare the safety and outcomes of EPP performed in the ER versus the OR.
• To evaluate the incidence of pelvic infections following EPP in different settings.

Main Methods:

• A retrospective study of patients undergoing EPP from 2009-2018.
• Patients were grouped based on EPP location (ER vs. OR) and matched using Propensity Score Matching (PSM).
• Microbiological analysis of surgical pads and early EPP removal (24-48h) post-stabilization were performed.

Main Results:

• No significant difference in pelvic infection rates between ER and OR EPP groups post-PSM.
• Patients undergoing EPP in the OR had more associated abdominal injuries and required more interventions like laparotomies and external fixation.
• Higher initial systolic blood pressure was noted in the OR group.

Conclusions:

• EPP is a safe and effective procedure for hemorrhage control, applicable even in the ER for unstable patients.
• Performing EPP in the ER can provide earlier bleeding control for critically ill patients.
• Timely removal of EPP after hemodynamic stabilization is crucial for minimizing infection risk.