Relationship Between Door-to-Embolization Time and Clinical Outcomes After Transarterial Embolization in Trauma Patients With Severe Pelvic Fracture

Abstract

Background: While transarterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, the clinical outcomes according to door-to-embolization (DTE) time are unclear. This study investigated how DTE time affects outcomes in patients with severe pelvic fracture.Methods: Using a trauma database between November 1, 2015 and December 31, 2019, trauma patients undergoing TAE were retrospectively reviewed. The final study population included 204 patients treated with TAE. The relationships between DTE time and patients’ outcomes were evaluated. Multivariate binomial logistic regression analyses, multivariate linear regression analyses, and multivariate Cox hazard proportional regression analyses were performed to estimate the impacts of DTE time on clinical outcomes.Results: The median DTE time was 150 min (interquartile range, 123–186). The mortality rates at 7 and 28 days and overall were 8.3%, 13.7%, and 15.7%, respectively. DTE time served as an independent risk factor for mortality at 7 and 28 days (adjusted odds ratio = 1.62, 95% confidence interval [CI] = 1.14–2.30, p = 0.007; adjusted odds ratio = 1.48, CI = 1.05–2.07, p = 0.023, respectively). In multivariate Cox proportional hazards regression analyses, the adjusted hazard ratio of DTE time for mortality at 28 days was 1.28 (CI = 1.08–1.30, p = 0.005). In addition, there was a positive relationship between DTE time and requirement for packed red blood cell transfusion during the initial 24 h and a negative relationship between DTE time and ICU-free days to day 28.Conclusions: Shorter DTE time was associated with better survival at 7 and 28 days, as well as other clinical outcomes, in patients with severe pelvic fracture who underwent TAE. Efforts to minimize DTE time are recommended to improve the clinical outcomes in patients with pelvic fracture treated with TAE.