Abstract
IntroductionWhile transcatheter arterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, delayed TAE may increase mortality risk. The purpose of the current study was to determine how time to TAE affects outcomes in patients with pelvic fracture in the emergency department.MethodsFrom January 2014 to December 2016, the trauma registry and medical records of patients with pelvic fracture who underwent TAE were retrospectively reviewed. The relationship between the time to TAE and patient outcomes was evaluated. The characteristics of surviving and deceased patients were also compared to search for prognostic factors affecting survival.ResultsEighty-four patients were enrolled in the current study. Among patients with pelvic fracture who underwent TAE, the overall mortality rate was 16.7%. There were positive relationships between the time to TAE and the requirement for blood transfusion and between the time to TAE and intensive care unit (ICU) length of stay (LOS). Nonsurviving patients were significantly older (57.4 ± 23.3 vs. 42.7 ± 19.3 years old, p = 0.014) and had higher injury severity scores (ISSs) (36.4 ± 11.9 vs. 23.9 ± 10.9, p < 0.001) than were observed in surviving patients. There was no significant difference in the time to TAE between nonsurviving and surviving patients (76.9 ± 47.9 vs. 59.0 ± 29.3 min, p = 0.068). The multivariate logistic regression analysis showed that ISS and age served as independent risk factors for mortality. Every one unit increase in ISS or age resulted in a 1.154- or 1.140-fold increase in mortality, respectively (p = 0.033 and 0.005, respectively). However, the time to TAE serves as an independent factor for ICU LOS (p = 0.015).ConclusionIn pelvic fracture patients who require TAE for hemostasis, longer time to TAE may cause harm. An early hemorrhage control is suggested.
Highlights
While transcatheter arterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, delayed TAE may increase mortality risk
According to the trauma registry databank maintained by our institution, a total of 609 patients with pelvic fractures who were admitted to our emergency department (ED) from January 2014 to December 2016 were evaluated
The physical data of these patients showed that they had a mean systolic blood pressure (SBP) of 102.8 ± 34.9 mmHg, a mean Glasgow Coma Scale (GCS) of 12.1 ± 4.4, a mean base deficit (BD) of 9.8 ± 6.0 mm/L, and a mean lactate level of 51.4 ± 34.0 mg/dL
Summary
While transcatheter arterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, delayed TAE may increase mortality risk. The purpose of the current study was to determine how time to TAE affects outcomes in patients with pelvic fracture in the emergency department. 5% to 20% of patients have unstable hemodynamics, and hemorrhage-related mortality rates as high as 40% have been reported [4]. The success rate of TAE is high, the mortality rates reported in patients receiving TAE range from 16% to 50% among previous studies [11, 22]. While a patient waits for TAE, ongoing hemorrhage may increase his or her mortality risk over time. Performing TAE less than 3 h after admission leads to better outcomes, but many previous studies have shown that it is difficult to achieve this goal [6, 7, 19, 22,23,24,25]
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