Comparative effectiveness of pelvic arterial embolization versus laparotomy in adults with pelvic injuries: A National Trauma Data Bank analysis

Abuzar Moradi Tuchayi; Nariman Nezami; Yuchen Zhang; Tarek N Hanna; Jamlik-Omari Johnson; Janice Newsome; Sijian Fan; Richard Duszak Jr; Elizabeth R Benjamin; Jonathan Nguyen; Michael A Maceroli; April A Grant; Deepika Koganti; Laura K Findeiss; Nima Kokabi

doi:10.1016/j.clinimag.2022.03.008

Comparative effectiveness of pelvic arterial embolization versus laparotomy in adults with pelvic injuries: A National Trauma Data Bank analysis

Clin Imaging. 2022 Jun:86:75-82. doi: 10.1016/j.clinimag.2022.03.008. Epub 2022 Mar 14.

Authors

Affiliations

¹ Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: abuzar.moradi.tuchayi@emory.edu.
² Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine University of Maryland School of Medicine, Baltimore, MD, USA; Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.
³ Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA. Electronic address: yz92460@uga.edu.
⁴ Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: tarek.hanna@emory.edu.
⁵ Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: jamlik.johnson@emoryhealthcare.org.
⁶ Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: Janice.newsome@emoryhealthcare.org.
⁷ Department of Biostatistics, University of South Carolina, Charleston, SC, USA. Electronic address: sfan@email.sc.edu.
⁸ Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: richard.duszak@emory.edu.
⁹ Division of Trauma Surgical Critical Care, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: elizabeth.robinson.benjamin@emory.edu.
¹⁰ Division of Trauma and Critical Care, Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA. Electronic address: jnguyen@msm.edu.
¹¹ Division of Trauma Surgical Critical Care, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: michael.a.maceroli@emory.edu.
¹² Division of Trauma Surgical Critical Care, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: april.a.grant@emory.edu.
¹³ Division of Trauma Surgical Critical Care, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: deepika.koganti@emory.edu.
¹⁴ Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: laura.findeiss@emory.edu.
¹⁵ Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: nima.kokabi@emory.edu.

PMID: 35367866
DOI: 10.1016/j.clinimag.2022.03.008

Abstract

Purpose: To compare the clinical outcomes and trends of arterial embolization (AE) versus laparotomy which are used in the management of pelvic trauma.

Materials and methods: Adult patients with pelvic injuries were identified using the National Trauma Data Bank (NTDB) from 2007 to 2015. Patients with non-pelvic life-threatening injuries were excluded. Patients were grouped in operatively managed pelvic ring injuries, laparotomy ± fixation, AE ± fixation, and laparotomy and AE ± fixation. Using a linear mixed regression and logistic regression models, hospital length of stay (LOS), ICU days, ventilator days, and mortality for different therapies were compared. A propensity score weighting method was used to further eliminate treatment selection bias in the study sample and compare the outcomes between AE and laparotomy.

Results: Of 7473 pelvic trauma patients, 1226 (16.4%) patients were only operatively managed. 3730 patients (49.9%) underwent laparotomy, 2136 underwent AE (28.6%), and 381 (5.1%) patients underwent both laparotomy and AE. The year of injury, patient age, gender, race, severity of injury and presence of shock were found to be predictors of receipt of different therapies (P < 0.001 for all). When correcting for these confounding factors, the mortality rate was lower in the AE group compared to the laparotomy group 6.6% vs. 20.6% (P < 0.001). Additionally, LOS and ICU days were shorter for the AE group than the laparotomy group (P < 0.001).

Conclusion: AE in patients with pelvic injuries is associated with lower mortality, as well as shorter LOS and ICU stays compared to laparotomy.

Keywords: Embolization; Injury; Laparotomy; Pelvis; Trauma.

MeSH terms

Adult
Embolization, Therapeutic* / methods
Humans
Injury Severity Score
Laparotomy*
Length of Stay
Retrospective Studies
Vascular Surgical Procedures