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

Abstract

PurposeTo 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 MethodsThis 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. ResultsOf 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%). ConclusionThis 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.