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Delayed embolization associated with increased mortality in pelvic fracture with hemodynamic stability at hospital arrival

Authors
  • Aoki, Makoto1, 2
  • Abe, Toshikazu3, 4
  • Matsumoto, Shokei1
  • Hagiwara, Shuichi5
  • Saitoh, Daizoh6
  • Oshima, Kiyohiro2
  • 1 Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan , Yokohama (Japan)
  • 2 Gunma University Graduate School of Medicine, Maebashi, Japan , Maebashi (Japan)
  • 3 Tsukuba Memorial Hospital, Tsukuba, Japan , Tsukuba (Japan)
  • 4 University of Tsukuba, Tsukuba, Japan , Tsukuba (Japan)
  • 5 Kiryu Kosei General Hospital, Kiryu, Japan , Kiryu (Japan)
  • 6 National Defense Medical College, Tokorozawa, Japan , Tokorozawa (Japan)
Type
Published Article
Journal
World Journal of Emergency Surgery
Publisher
Springer (Biomed Central Ltd.)
Publication Date
May 03, 2021
Volume
16
Issue
1
Identifiers
DOI: 10.1186/s13017-021-00366-z
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundEmbolization is widely used for controlling arterial hemorrhage associated with pelvic fracture. However, the effect of a delay in embolization among hemodynamically stable patients at hospital arrival with a pelvic fracture is unknown. Therefore, our aim was to investigate the association between the time to embolization and mortality in hemodynamically stable patients at hospital arrival with a pelvic fracture.MethodsA multicenter, retrospective cohort study was undertaken using data from the Japan Trauma Data Bank between 2004 and 2018. Hemodynamically, stable patients with a pelvic fracture who underwent an embolization within 3 h were divided into six groups of 30-min blocks of time until pelvic embolization (0–30, 30–60, 60–90, 90–120, 120–150, and 150–180 min). We compared the adjusted 30-day mortality rate according to time to embolization.ResultsWe studied 620 hemodynamically stable patients with a pelvic fracture who underwent pelvic embolization within 3 h of hemorrhage. The median age was 68 (48–79) years and 55% were male. The median injury severity score was 26 (18–38). Thirty-day mortality was 8.9% (55/620) and 24-h mortality was 4.2% (26/619). A Cochran–Armitage test showed that a 30-min delay for embolization was associated with increased 30-day (p = 0.0186) and 24-hour (p = 0.033) mortality. Mortality within 0–30 min to embolization was 0%. The adjusted 30-day mortality rate increased with delayed embolization and was up to 17.0% (10.2–23.9) for the 150–180 min group.ConclusionDelayed embolization was associated with increased mortality in pelvic fracture with hemodynamic stability at hospital arrival. When you decide to embolize pelvic fracture patients, the earlier embolization may be desirable to promote improved survival regardless of hemodynamics.

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