Outcomes of Transcatheter Arterial Embolization in Patients with Isolated Pelvic Fractures: A Japanese Nationwide Study Focused on Shock Status and Age.

Abstract

Purpose: To investigate the effect of transcatheter arterial embolization (TAE) on the 30-day survival of patients with isolated pelvic fractures, focusing on the influence of shock status and age.

Materials and methods: This retrospective cohort study used data from the Japan Trauma Data Bank (2004-2018). Patients with isolated pelvic fractures, defined by an Abbreviated Injury Scale score of ≥3, were included. Shock (shock index ≥1) and non-shock (shock index <1) were grouped. Inverse probability weighting using propensity scores was performed to adjust for the confounding factors. The primary outcome measure was the 30-day in-hospital mortality. The 30-day survival was compared by age groups: 0-19 years, 20-39 years, 40-59 years, 60-79 years and ≥80 years.

Results: Of the 5,025 eligible patients, 866 presented with shock, and 4,159 served as the non-shock group. The propensity score analysis showed that there was no significant difference in survival between the TAE and non-TAE groups in patients without shock (TAE group: 92.4% vs. non-TAE group: 92.5%; risk difference -0.05%, 95% confidence interval [CI]: -0.5% to 0.4%). Conversely, for patients with shock, the TAE group had a significantly higher 30-day survival rate than the non-TAE group (83.0% vs. 76.2%; risk difference 6.7%, 95% CI: 5.1% to 8.3%). Among the age groups, the risk difference was highest in the ≥80 years age group (78.5% vs. 66.6%, risk difference 11.9%, 95% CI: 7.7% to 16.1%).

Conclusion: This nationwide study suggested that provision of TAE is associated with improved 30-day survival in patients with isolated pelvic fractures and shock, particularly for those aged ≥80 years.