{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:46:13Z","timestamp":1787755573707,"version":"build-2784847793"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,10,19]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.22.00252","type":"journal-article","created":{"date-parts":[[2022,8,8]],"date-time":"2022-08-08T16:00:22Z","timestamp":1659974422000},"page":"1821-1829","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["Preperitoneal Pelvic Packing for Hypotension Has a Greater Risk of Venous Thromboembolism Than Angioembolization"],"prefix":"10.2106","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7494-7366","authenticated-orcid":false,"given":"Joseph T.","family":"Patterson","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7142-604X","authenticated-orcid":false,"given":"Julian","family":"Wier","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6326-2468","authenticated-orcid":false,"given":"Joshua L.","family":"Gary","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,8,8]]},"reference":[{"issue":"3","key":"bib1-20250430","first-page":"483","article-title":"Pelvic fracture: the last 50 years","volume":"69","author":"Flint","year":"2010","journal-title":"J Trauma."},{"key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/00003086-199608000-00009","article-title":"Angiographic findings in pelvic fractures","volume":"329","author":"O\u2019Neill","year":"1996","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.ocl.2004.06.002","article-title":"Pelvic fracture patterns and their corresponding angiographic sources of hemorrhage","volume":"35","author":"Metz","year":"2004","journal-title":"Orthop Clin North Am."},{"issue":"24","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1056\/NEJM199412153312401","article-title":"A prospective study of venous thromboembolism after major trauma","volume":"331","author":"Geerts","year":"1994","journal-title":"N Engl J Med."},{"issue":"7","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1097\/00005373-199007000-00015","article-title":"Pelvic ring disruptions: effective classification system and treatment protocols","volume":"30","author":"Burgess","year":"1990","journal-title":"J Trauma."},{"issue":"3","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1097\/00005373-200209000-00009","article-title":"The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions","volume":"53","author":"Eastridge","year":"2002","journal-title":"J Trauma."},{"issue":"1)(Suppl","key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1097\/01.bot.0000202386.86880.21","article-title":"Circumferential pelvic antishock sheeting: a temporary resuscitation aid","volume":"20","author":"Routt","year":"2006","journal-title":"J Orthop Trauma."},{"issue":"4","key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.amjsurg.2020.05.037","article-title":"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","volume":"220","author":"Bugaev","year":"2020","journal-title":"Am J Surg."},{"issue":"5","key":"bib9-20250430","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1097\/TA.0000000000001034","article-title":"Current management of hemorrhage from severe pelvic fractures: results of an American Association for the Surgery of Trauma multi-institutional trial","volume":"80","author":"Costantini","year":"2016","journal-title":"J Trauma Acute Care Surg."},{"issue":"6","key":"bib10-20250430","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1097\/TA.0000000000001230","article-title":"Western Trauma Association critical decisions in trauma: management of pelvic fracture with hemodynamic instability-2016 updates","volume":"81","author":"Tran","year":"2016","journal-title":"J Trauma Acute Care Surg."},{"issue":"4","key":"bib11-20250430","first-page":"834","article-title":"Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift","volume":"62","author":"Cothren","year":"2007","journal-title":"J Trauma."},{"issue":"2","key":"bib12-20250430","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1097\/TA.0000000000001324","article-title":"Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures","volume":"82","author":"Burlew","year":"2017","journal-title":"J Trauma Acute Care Surg."},{"issue":"8","key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1016\/j.injury.2020.06.003","article-title":"Pre-peritoneal pelvic packing for early hemorrhage control reduces mortality compared to resuscitative endovascular balloon occlusion of the aorta in severe blunt pelvic trauma patients: a nationwide analysis","volume":"51","author":"Mikdad","year":"2020","journal-title":"Injury."},{"issue":"6","key":"bib14-20250430","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1016\/j.amjsurg.2020.08.043","article-title":"Worth looking! Venous thromboembolism in patients who undergo preperitoneal pelvic packing warrants screening duplex","volume":"220","author":"Heelan","year":"2020","journal-title":"Am J Surg."},{"issue":"12","key":"bib15-20250430","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1097\/BOT.0000000000001583","article-title":"Preperitoneal pelvic packing is not associated with an increased risk of surgical site infections after internal anterior pelvic ring fixation","volume":"33","author":"Stahel","year":"2019","journal-title":"J Orthop Trauma."},{"issue":"6","key":"bib16-20250430","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/00005131-200108000-00003","article-title":"Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur","volume":"15","author":"Adams","year":"2001","journal-title":"J Orthop Trauma."},{"issue":"1","key":"bib17-20250430","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1001\/jamasurg.2016.3116","article-title":"Association of mechanism of injury with risk for venous thromboembolism after trauma","volume":"152","author":"Karcutskie","year":"2017","journal-title":"JAMA Surg."},{"issue":"3","key":"bib18-20250430","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.injury.2019.02.009","article-title":"Timing of venous thromboprophylaxis in isolated severe pelvic fracture: Effect on mortality and outcomes","volume":"50","author":"Benjamin","year":"2019","journal-title":"Injury."},{"issue":"1","key":"bib19-20250430","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s13017-016-0077-2","article-title":"Efficacy of extra-peritoneal pelvic packing in hemodynamically unstable pelvic fractures, a propensity score analysis","volume":"11","author":"Chiara","year":"2016","journal-title":"World J Emerg Surg."},{"issue":"11","key":"bib20-20250430","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/0895-4356(94)90129-5","article-title":"Validation of a combined comorbidity index","volume":"47","author":"Charlson","year":"1994","journal-title":"J Clin Epidemiol."},{"issue":"1","key":"bib21-20250430","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/TA.0000000000002062","article-title":"American College of Surgeons Committee on Trauma verification level affects trauma center management of pelvic ring injuries and patient mortality","volume":"86","author":"Oliphant","year":"2019","journal-title":"J Trauma Acute Care Surg."},{"issue":"5","key":"bib22-20250430","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1097\/BOT.0000000000000250","article-title":"Dalteparin in Knee-to-Ankle Fracture) Investigators. A double-blind, randomized controlled trial of the prevention of clinically important venous thromboembolism after isolated lower leg fractures","volume":"29","author":"Selby","year":"2015","journal-title":"J Orthop Trauma."},{"issue":"2","key":"bib24-20250430","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1093\/biomet\/66.2.237","article-title":"A Bayesian extension of the minimum AIC procedure of autoregressive model fitting","volume":"66","author":"Akaike","year":"1979","journal-title":"Biometrika."},{"issue":"2","key":"bib25-20250430","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1002\/pst.433","article-title":"Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies","volume":"10","author":"Austin","year":"2011","journal-title":"Pharm Stat."},{"issue":"2","key":"bib26-20250430","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1093\/aje\/kwt212","article-title":"Selecting an appropriate caliper can be essential for achieving good balance with propensity score matching","volume":"179","author":"Lunt","year":"2014","journal-title":"Am J Epidemiol."},{"issue":"4","key":"bib27-20250430","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1097\/00013611-199400940-00004","article-title":"The technique of packing for control of hemorrhage in complex pelvic fractures","volume":"9","author":"Pohlemann","year":"1994","journal-title":"Tech Orthop."},{"issue":"1","key":"bib28-20250430","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/1752-2897-5-6","article-title":"Intraoperative angioembolization in the management of pelvic-fracture related hemodynamic instability","volume":"5","author":"Cherry","year":"2011","journal-title":"J Trauma Manag Outcomes."},{"issue":"Pt B","key":"bib29-20250430","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.ijsu.2016.02.057","article-title":"Pelvic angioembolization in trauma - indications and outcomes","volume":"33","author":"Salcedo","year":"2016","journal-title":"Int J Surg."},{"issue":"5","key":"bib30-20250430","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1097\/01586154-201305000-00026","article-title":"American College of Surgeons\u2019 Committee on Trauma; International ATLS Working Group. Advanced Trauma Life Support (ATLS\u00ae): The ninth edition","volume":"74","author":"The ATLS Subcommittee","year":"2013","journal-title":"J Trauma Acute Care Surg."},{"issue":"6","key":"bib31-20250430","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1001\/jamasurg.2019.0096","article-title":"Nationwide analysis of resuscitative endovascular balloon occlusion of the aorta in civilian trauma","volume":"154","author":"Joseph","year":"2019","journal-title":"JAMA Surg."},{"issue":"2","key":"bib32-20250430","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1097\/BOT.0000000000002191","article-title":"Resuscitative endovascular balloon occlusion of the aorta in hemodynamically unstable patients with pelvic ring injuries","volume":"36","author":"Marchand","year":"2022","journal-title":"J Orthop Trauma."},{"issue":"5","key":"bib33-20250430","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1007\/s00264-015-2698-6","article-title":"Post-traumatic thrombo-embolic complications in polytrauma patients","volume":"39","author":"Lichte","year":"2015","journal-title":"Int Orthop."},{"issue":"6","key":"bib34-20250430","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1016\/j.jcot.2020.08.017","article-title":"Risk factors for complications and in-hospital mortality: an analysis of 19,834 open pelvic ring fractures","volume":"11","author":"Frane","year":"2020","journal-title":"J Clin Orthop Trauma."},{"issue":"6","key":"bib35-20250430","doi-asserted-by":"crossref","first-page":"e517","DOI":"10.3928\/01477447-20140528-50","article-title":"Multiple lower-extremity and pelvic fractures increase pulmonary embolus risk","volume":"37","author":"Godzik","year":"2014","journal-title":"Orthopedics."},{"issue":"1","key":"bib36-20250430","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.injury.2009.06.010","article-title":"Venous thromboembolism after severe trauma: incidence, risk factors and outcome","volume":"41","author":"Paffrath","year":"2010","journal-title":"Injury."},{"key":"bib37-20250430","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.jss.2020.08.077","article-title":"When is it safe to start pharmacologic venous thromboembolism prophylaxis after pelvic fractures? A prospective study from a Level I trauma center","volume":"258","author":"Schellenberg","year":"2021","journal-title":"J Surg Res."},{"issue":"1","key":"bib38-20250430","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1186\/s13018-021-02510-6","article-title":"Perioperative red blood cell infusion and deep vein thrombosis in patients with femoral and pelvic fractures: a propensity score matching","volume":"16","author":"Wu","year":"2021","journal-title":"J Orthop Surg Res."},{"issue":"2","key":"bib39-20250430","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1001\/jamasurg.2014.1841","article-title":"Surgical duration and risk of venous thromboembolism","volume":"150","author":"Kim","year":"2015","journal-title":"JAMA Surg."},{"issue":"6","key":"bib40-20250430","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1016\/S0025-6196(11)61526-7","article-title":"Duration of anesthesia and venous thromboembolism after hip and knee arthroplasty","volume":"80","author":"Jaffer","year":"2005","journal-title":"Mayo Clin Proc."},{"issue":"1","key":"bib41-20250430","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1159\/000068427","article-title":"Principle mechanisms underlying venous thromboembolism: epidemiology, risk factors, pathophysiology and pathogenesis","volume":"70","author":"Kroegel","year":"2003","journal-title":"Respiration."},{"issue":"10","key":"bib42-20250430","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1177\/1060028014539920","article-title":"Association of deep-vein thrombosis (DVT) with missed doses of prophylactic antithrombotic medications in ICU patients: a case-control study","volume":"48","author":"Voils","year":"2014","journal-title":"Ann Pharmacother."},{"issue":"2","key":"bib43-20250430","doi-asserted-by":"crossref","first-page":"85","DOI":"10.5847\/wjem.j.1920-8642.2018.02.001","article-title":"Effect of angioembolization versus surgical packing on mortality in traumatic pelvic haemorrhage: a systematic review and meta-analysis","volume":"9","author":"Muntasar","year":"2018","journal-title":"World J Emerg Med."},{"issue":"1","key":"bib44-20250430","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jamcollsurg.2020.08.763","article-title":"Resuscitative endovascular balloon occlusion of the aorta vs pre-peritoneal packing in patients with pelvic fracture","volume":"232","author":"Asmar","year":"2021","journal-title":"J Am Coll Surg."},{"issue":"4","key":"bib45-20250430","first-page":"E79","article-title":"Retroperitoneal pelvic packing in the management of hemodynamically unstable pelvic fractures: a level I trauma center experience","volume":"71","author":"Tai","year":"2011","journal-title":"J Trauma."},{"issue":"1","key":"bib46-20250430","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.injury.2008.08.038","article-title":"Direct retroperitoneal pelvic packing versus pelvic angiography: a comparison of two management protocols for haemodynamically unstable pelvic fractures","volume":"40","author":"Osborn","year":"2009","journal-title":"Injury."},{"issue":"3","key":"bib47-20250430","doi-asserted-by":"crossref","first-page":"148","DOI":"10.4103\/2229-5151.190655","article-title":"Controlling hemorrhage in exsanguinating pelvic fractures: utility of extraperitoneal pelvic packing as a damage control procedure","volume":"6","author":"Hsu","year":"2016","journal-title":"Int J Crit Illn Inj Sci."},{"issue":"2","key":"bib48-20250430","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.injury.2015.10.008","article-title":"Retroperitoneal packing or angioembolization for haemorrhage control of pelvic fractures\u2014quasi-randomized clinical trial of 56 haemodynamically unstable patients with Injury Severity Score \u226533","volume":"47","author":"Li","year":"2016","journal-title":"Injury."},{"issue":"3","key":"bib49-20250430","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/j.jvs.2011.02.058","article-title":"Duplex ultrasound screening detects high rates of deep vein thromboses in critically ill trauma patients","volume":"54","author":"Azarbal","year":"2011","journal-title":"J Vasc Surg."},{"key":"bib50-20250430","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.ijsu.2018.01.023","article-title":"Trauma patients with lower extremity and pelvic fractures: should anti-factor Xa trough level guide prophylactic enoxaparin dose?","volume":"51","author":"Dhillon","year":"2018","journal-title":"Int J Surg."},{"key":"bib51-20250430","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s13037-019-0201-9","article-title":"Variability in the timeliness of interventional radiology availability for angioembolization of hemodynamically unstable pelvic fractures: a prospective survey among U.S. level I trauma centers","volume":"13","author":"Jarvis","year":"2019","journal-title":"Patient Saf Surg."},{"issue":"10","key":"bib52-20250430","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1016\/j.injury.2010.11.062","article-title":"Haemorrhage control in pelvic fractures\u2014a survey of surgical capabilities","volume":"42","author":"Metcalfe","year":"2011","journal-title":"Injury."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.22.00252","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:45:08Z","timestamp":1787751908000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.22.00252"}},"subtitle":["Management of Refractory Hypotension in Closed Pelvic Ring Injury"],"short-title":[],"issued":{"date-parts":[[2022,8,8]]},"references-count":51,"journal-issue":{"issue":"20","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.22.00252","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,8]]}}}