Abstract
PurposeThe aim of this study was to evaluate the association between the implementation of pelvic angiography (PA) and outcome in emergency pediatric patients with pelvic fracture.MethodsWe extracted data on pelvic fracture patients aged ≤ 19 years between 2004 and 2015 from a nationwide trauma registry in Japan. The main outcome was hospital mortality. We assessed the relationship between implementation of PA and hospital mortality using one-to-one propensity-score-matching analysis to reduce potential confounding effects in comparing the PA group with the non-PA group.ResultsIn total, 1351 patients were eligible for our analysis, with 221 patients (16.4%) included in the PA group and 1130 patients (83.6%) included in the non-PA group. For all patients, the proportion of hospital mortality was higher in the PA group than in the non-PA group [13.6% (30/221) vs 7.1% (80/1130), crude odds ratio (OR) 2.062 (95% confidence interval (CI), 1.318–3.224); p = 0.002]. In the propensity-score-matched patients, the proportion of hospital mortality was lower in the PA group than in the non-PA group [10.5% (22/200) vs 18.2% (38/200), p = 0.027]. This finding was confirmed in both the multivariable logistic regression model [adjusted OR 0.392 (95% CI, 0.171–0.896); p = 0.026] and the conditional logistic regression model [conditional OR 0.484 (95% CI, 0.261–0.896); p = 0.021].ConclusionThe implementation of PA was significantly associated with lower hospital mortality among emergency pediatric patients with pelvic fractures compared with the non-implementation of PA.
Highlights
Pelvic fracture is one of the severe traumas associated with high mortality due to fatal bleeding
After excluding 341 patients for the reasons shown in Fig. 1, 1351 patients were eligible for our analysis, with 221 patients (16.4%) included in the pelvic angiography (PA) group and 1130 patients (83.6%) included in the non-PA group
Among all patients before PS matching, those in the PA group were more likely to be older, have shock on hospital arrival and a high Injury Severity Score (ISS) score, and to have received injuries to the abdomen and lower extremities including the pelvis with an Abbreviated Injury Scale (AIS) score of three or more compared with those in the non-PA group
Summary
Pelvic fracture is one of the severe traumas associated with high mortality due to fatal bleeding. According to the Eastern Association for the Surgery of Trauma (EAST) guidelines, emergency PA is recommended for adult patients with pelvic fractures who show hemodynamic instability, signs of ongoing bleeding after non-pelvic sources of blood loss, or arterial intravenous contrast extravasation in the pelvis by enhanced computed tomography (CT) [1]. Falzarano and colleagues reported that 16.5% (87/528) of pelvic fracture patients had hemodynamic instability, and 11.9% (63/528) of them received emergency angiography and embolization [2]. It is difficult to select appropriate sheathes and catheters for pediatric patients with pelvic fractures, because the body size of children is smaller than that of adults. Angiography or arterial embolization for emergency pediatric patients with pelvic fractures is rarely performed. There were some case series and case reports on angiography and catheter embolization in these patients [6,7,8,9,10], the effectiveness of PA in them has not been extensively investigated
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