Outcomes of Transarterial Embolization in Patients with Isolated Pelvic Fractures: A Japanese Nationwide Study Focused on Shock Status and Age

Purpose: To investigate the effect of transarterial embolization (TAE) on the 30-day survival of patients with isolated pelvic fractures, focusing on the influence of shock status and age. Materials and Methods: This retrospective cohort study used data from the Japan Trauma Data Bank (2004-2018). Patients with isolated pelvic fractures, defined by an Abbreviated Injury Scale score of >= 3, were included. Shock (shock index, >= 1) and nonshock (shock index, <1) were grouped. Inverse probability weighting using propensity scores was performed to adjust for the confounding factors. The primary outcome measure was the 30-day in-hospital mortality. The 30-day survival was compared by age groups: 0-19 years, 20-39 years, 40-59 years, 60-79 years, and >= 80 years. Results: Of the 5,025 eligible patients, 866 presented with shock, and 4,159 served as the nonshock group. The propensity score analysis showed that there was no significant difference in survival between the TAE and non-TAE groups in patients without shock (TAE group vs non-TAE group, 92.4% vs 92.5%; risk difference, -0.05%; 95% CI, -0.5% to 0.4%). Conversely, for patients with shock, the TAE group had a significantly higher 30-day survival rate than the non-TAE group (83.0% vs 76.2%; risk difference, 6.7%; 95% CI, 5.1%-8.3%). Among the age groups, the risk difference was highest in the >= 80 years age group (78.5% vs 66.6%; risk difference, 11.9%; 95% CI, 7.7%-16.1%). Conclusions: This nationwide study suggested that provision of TAE was associated with improved 30-day survival in patients with isolated pelvic fractures and shock, particularly for those aged >= 80 years.