Department of Emergency Medicine, Yokohama City University, Minamiku, Yokohama City, Kanagawa Prefecture, Japan.
Department of Emergency Medicine, Yokohama City University, Minamiku, Yokohama City, Kanagawa Prefecture, Japan.
Eur J Vasc Endovasc Surg. 2022 Aug-Sep;64(2-3):234-242. doi: 10.1016/j.ejvs.2022.05.048. Epub 2022 Jun 13.
The objective of this study was to determine the association between arterial embolisation (AE) for pelvic fractures and death.
The study had a retrospective design, using data from a nationwide population based prospective registry of trauma patients in Japan. This propensity score matched study included all adult patients from the registry with pelvic fractures between January 2004 and December 2018. The primary outcome was hospital death. Secondary outcomes included 28 day survival and length of hospital stay (LOS) in days. Multivariable logistic regression analyses were performed to control confounding variables, including patient, clinical, and hospital related variables; concomitant trauma; severe trauma; and haemodynamic instability. A conditional logistic regression analysis was performed to assess the association between treatment of pelvic fracture with AE and hospital mortality rate.
Among 17 670 eligible patients with pelvic fractures, 2 379 (13.5%) underwent AE (AE group) and 1 512 (8.6%) died in the hospital. After one to one propensity matching with 2 138 patients from each group (AE and non-AE), the hospital mortality rate was significantly lower in the AE group than in the non-AE group (15.0% vs. 18.1%; p = .007). The AE group had significantly lower mortality (odds ratio; 95% confidence interval [CI] 0.60; 0.43 - 0.84; p = .003) and a significantly higher 28 day mean survival rate than the non-AE group (0.89; 95% CI 0.87 - 0.90 vs. 0.86; 0.85 - 0.88; p = .003), although there was no significant difference in the LOS (48 days vs. 46 days; p = .11).
This propensity score matched analysis showed an association between AE for pelvic fractures and lower hospital mortality rates. The findings in this large nationwide cohort study provide strong evidence for the benefit of embolisation for patients with pelvic fractures.
本研究旨在确定骨盆骨折动脉栓塞（AE）与死亡之间的关联。
本研究采用回顾性设计，使用日本全国创伤患者前瞻性登记处的数据。这项倾向评分匹配研究纳入了 2004 年 1 月至 2018 年 12 月登记处所有骨盆骨折的成年患者。主要结局是院内死亡。次要结局包括 28 天生存率和住院时间（LOS）。多变量逻辑回归分析用于控制混杂变量，包括患者、临床和医院相关变量；合并创伤；严重创伤；和血流动力学不稳定。条件逻辑回归分析用于评估骨盆骨折 AE 治疗与医院死亡率之间的关联。
在 17670 名符合条件的骨盆骨折患者中，2379 名（13.5%）接受了 AE（AE 组），1512 名（8.6%）在医院死亡。在对每组（AE 组和非-AE 组）各 2138 名患者进行一对一倾向评分匹配后，AE 组的院内死亡率明显低于非-AE 组（15.0% vs. 18.1%；p =.007）。AE 组的死亡率明显更低（比值比；95%置信区间 [CI] 0.60；0.43 - 0.84；p =.003），28 天平均生存率明显高于非-AE 组（0.89；95% CI 0.87 - 0.90 vs. 0.86；0.85 - 0.88；p =.003），尽管 LOS 无显著差异（48 天 vs. 46 天；p =.11）。
这项倾向评分匹配分析显示，骨盆骨折的 AE 与较低的院内死亡率之间存在关联。这项大型全国队列研究的结果为骨盆骨折患者栓塞治疗的益处提供了有力证据。
