A retrospective observational study assessing mortality after pelvic trauma embolisation
Warren Clements, Talulla Dunne, Steven Clare, Matthew Lukies, Mark Fitzgerald, Joseph Mathew, Helen Kavnoudias, Adil Zia, Ee Jun Ban, Annabelle Skelley, Jim Koukounaras- Radiology, Nuclear Medicine and imaging
- Oncology
Abstract
Introduction
Trauma to the pelvic ring and associated haemorrhage represent a management challenge for the multidisciplinary trauma team. In up to 10% of patients, bleeding can be the result of an arterial injury and mortality is reported as high as 89% in this cohort. We aimed to assess the mortality rate after pelvic trauma embolisation and whether earlier embolisation improved mortality.
Methods
Retrospective study at single tertiary trauma and referral centre, between 1 January 2009 and 30 June 2022. All adult patients who received embolisation following pelvic trauma were included. Patients were excluded if angiography was performed but no embolisation performed.
Results
During the 13.5‐year time period, 175 patients underwent angiography and 28 were excluded, leaving 147 patients in the study. The all‐cause mortality rate at 30‐days was 11.6% (17 patients). The median time from injury to embolisation was 6.3 h (range 2.8–418.4). On regression analysis, time from injury to embolisation was not associated with mortality (OR 1.01, 95% CI 0.952–1.061). Increasing age (OR 1.20, 95% CI 1.084–1.333) and increasing injury severity score (OR 1.14, 95% CI 1.049–1.247) were positively associated with all‐cause 30‐day mortality, while non‐selective embolisation (OR 0.11, 95% CI 0.013–0.893) was negatively associated.
Conclusion
The all‐cause mortality rate at 30‐days in or cohort was very low. In addition, earlier time from injury to embolisation was not positively associated with all‐cause 30‐day mortality. Nevertheless, minimising this remains a fundamental principle of the management of bleeding in pelvic trauma.