Abstract
This study investigated the risk factors for in-hospital mortality of severe blunt trauma patients who underwent transcatheter arterial embolization (TAE). We analysed data from the Japan Trauma Data Bank from 2009 to 2018. Patients with severe blunt trauma and an Injury Severity Score (ISS) ≥ 16 who underwent TAE were enrolled. The primary analysis evaluated patient characteristics and outcomes, and variables with significant differences were included in the secondary multivariate logistic regression analysis. In total, 5800 patients (6.4%) with ISS ≥ 16 underwent TAE. There were significant differences in the proportion of male patients, transportation method, injury mechanism, injury region, Revised Trauma Score, survival probability values, and those who underwent urgent blood transfusion and additional urgent surgery. In multivariable regression analyses, higher age, urgent blood transfusion, and initial urgent surgery were significantly associated with higher in-hospital mortality risk [p < 0.001, odds ratio (OR), 95% confidence interval (CI): 1.01 (1.00–1.01); p < 0.001, 3.50 (2.55–4.79); and p = 0.001, 1.36 (1.13–1.63), respectively]. Inter-hospital transfer was significantly associated with lower in-hospital mortality risk (p < 0.001, OR = 0.56, 95% CI = 0.44–0.71). Treatment protocols for urgent intervention before and after TAE and a safe, rapid inter-hospital transport system are needed to improve mortality risks for severe blunt trauma patients.
Highlights
The mortality and morbidity rates for severe blunt trauma with active bleeding remains significantly high [1,2,3,4]
There was no significant difference between the age-stratified subgroups in the rate of incidence of transcatheter arterial embolization (TAE) in severe blunt trauma patients (1.1%, 5.7%, 8.4%, 8.2%, 7.2%, 6.1%, 5.4%, 5.7%, 6.6%, and 6.9%, respectively, p = 0.437), patients aged 0–5 years had a lower late of incidence of TAE than those in the other subgroups
Inter-hospital transfer was significantly associated with survival benefit for patients with severe blunt trauma who underwent TAE
Summary
The mortality and morbidity rates for severe blunt trauma with active bleeding remains significantly high [1,2,3,4]. With the advances in endovascular techniques for these patients, some reports have suggested that TAE in conjunction with surgery and/or urgent blood transfusion can more efficiently improve the mortality risk [10,11,12,13]. It remains unclear which of the therapeutic strategies among these two interventions is more appropriate for patients with blunt trauma in a haemodynamically unstable state
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