A short decision time for transcatheter embolization can better associate mortality in patients with pelvic fracture: a retrospective study

Abstract

Background: Early use of hemostasis strategies, transcatheter arterial embolization (TAE) is critical in cases of pelvic injury because of the risk of hemorrhagic shock and other fatal injuries. We investigated the influence of delays in TAE administration on mortality.

Methods: Patients admitted to the Advanced Critical Care Center at Gifu University with pelvic injury between January 2008 and December 2019, and who underwent acute TAE, were retrospectively enrolled. The time from when the doctor decided to administer TAE to the start of TAE (needling time) was defined as "decision-TAE time."

Results: We included 158 patients, of whom 23 patients died. The median decision-TAE time was 59.5 min. Kaplan-Meier curves for overall survival were compared between patients with decision-TAE time above and below the median cutoff value; survival was significantly better for patients with values below the median cutoff value (p = 0.020). Multivariable Cox proportional hazards regression analysis revealed that the longer the decision-TAE time, the higher the risk of mortality (p = 0.031). TAE duration modified the association between decision-TAE time and overall survival (p = 0.109), as shorter TAE duration (procedure time) was associated with the best survival rate (p for interaction = 0.109).

Conclusion: Decision-TAE time may play a key role in establishing resuscitation procedures in patients with pelvic fracture, and efforts to shorten this time should be pursued.

Keywords: hemostasis strategies; mortality; pelvic injury; retrospective study; transcatheter arterial embolization.

Figure 1

Treatment algorithm for pelvic injury. CT, computed tomography; TAE, transarterial catheter embolization.

Figure 2

Definition of “Decision-TAE” time In the CT (CT-TAE) group, the decision-TAE time is defined as the time from the start of CT to the administration of TAE. In the door-TAE group, the decision-TAE time is defined as the time from arrival to administration of TAE. TAE, transarterial catheter embolization; CT, computed tomography.

Figure 3

Patient selection. Flowchart diagram of eligible and excluded patients. OHCA, out-of-hospital cardiac arrest; TAE, transarterial catheter embolization; PPP, pre-peritoneal packing.

Figure 4

Kaplan–Meier curves of overall survival. The vertical axis shows the cumulative survival rate by Kaplan–Meier estimation. The horizontal axis shows the number of days since the baseline day. Marks in the curve indicate data censoring. The Kaplan–Meier curves of overall survival are compared, and a significant difference is observed between the patients above and below the median cutoff value for decision-TAE time (p = 0.02). TAE, transarterial catheter embolization.

Figure 5

Interaction between TAE duration and decision-TAE time. Predicted plots of hazard ratios by Performed TAE time with median decision-TAE time as a reference are shown; the three solid lines correspond to the 25th, 50th, and 75th percentile of Performed TAE time, respectively. The gray shaded areas indicate 95% confidence intervals. Although the interaction between TAE duration and decision-TAE time is not significant (p = 0.109), TAE duration modified the effect of decision-TAE time on mortality. TAE, transarterial catheter embolization.