Takashima Shogo, Yamakawa Kazuma, Hisamune Ryo, Ushio Noritaka, Endo Akira, Yamamoto Ryo, Yamamoto Kazuhiro, Osuga Keigo, Takasu Akira
Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.
Department of Acute Critical Care Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
Eur Radiol. 2025 Jun 6. doi: 10.1007/s00330-025-11743-6.
As with surgery, transcatheter arterial embolization is effective in managing arterial bleeding from trauma-related pelvic fractures and organ injuries. High-volume hospitals generally achieve better outcomes due to provider experience, but whether this applies to interventional radiology (IR) in trauma care remains unclear. This study examined whether hospitals with higher IR volumes improve outcomes for trauma patients.
This retrospective cohort study used data on trauma patients undergoing emergency IR within the torso from the Japan Trauma Data Bank. Hospitals were categorized by annual emergency IR case volume: 1-6 (Category 1), 7-12 (Category 2), 13-18 (Category 3), 19-24 (Category 4), and > 24 cases (Category 5). The association between hospital volume and in-hospital mortality was analyzed with a mixed-effects logistic regression model adjusted for injury severity. Subgroup analyses conducted by dividing the 18-year study period into three intervals, 2004-2009, 2010-2015, and 2016-2021, assessed the time-related impact of volume on outcomes.
We analyzed 16,090 trunk-IR patients from 303 hospitals. In-hospital mortality rates were 16.2%, 13.9%, 14.3%, 13.1%, and 11.8% for Categories 1 to 5, respectively. Higher volumes of IR cases were associated with reduced mortality. When the annual case number was analyzed as a continuous variable, an increase of one was associated with decreased mortality (odds ratio = 0.988, 95% confidence interval = 0.982-0.994, p < 0.001). Subgroup analyses showed a significant association between higher volume and reduced mortality during 2004-2009 and 2010-2015, but not during 2016-2021.
High-volume hospitals were associated with lower in-hospital mortality among patients undergoing emergency trunk IR.
Question The relationship between patient volume and clinical outcome is unknown for trauma patients undergoing emergency radiological interventions of the torso. Findings Higher hospital volumes of interventional radiology procedures performed in the trunk were associated with reduced in-hospital mortality. Clinical relevance Centralizing emergency interventional radiology cases, advancing trauma care education, and increasing awareness of interventional radiology can lead to better patient outcomes.
与外科手术一样，经导管动脉栓塞术在处理创伤相关骨盆骨折和器官损伤引起的动脉出血方面是有效的。由于医疗人员的经验，大型医院通常能取得更好的治疗效果，但这是否适用于创伤治疗中的介入放射学（IR）仍不清楚。本研究调查了IR手术量较高的医院是否能改善创伤患者的治疗效果。
这项回顾性队列研究使用了日本创伤数据库中接受躯干急诊IR的创伤患者的数据。医院按年度急诊IR病例数分类：1 - 6例（第1类）、7 - 12例（第2类）、13 - 18例（第3类）、19 - 24例（第4类）和>24例（第5类）。采用混合效应逻辑回归模型分析医院手术量与院内死亡率之间的关联，并对损伤严重程度进行校正。通过将18年的研究期分为三个时间段，即2004 - 2009年、2010 - 2015年和2016 - 2021年进行亚组分析，评估手术量对治疗效果的时间相关影响。
我们分析了来自303家医院的16,090例躯干IR患者。第1至5类医院的院内死亡率分别为16.2%、13.9%、14.3%、13.1%和11.8%。IR病例数越多，死亡率越低。当将年度病例数作为连续变量进行分析时，病例数每增加1例，死亡率就降低（比值比 = 0.988，95%置信区间 = 0.982 - 0.994，p < 0.001）。亚组分析显示，在2004 - 2009年和2010 - 2015年期间，手术量较高与死亡率降低之间存在显著关联，但在2016 - 2021年期间不存在这种关联。
大型医院与接受躯干急诊IR的患者较低的院内死亡率相关。
问题 对于接受躯干急诊放射学干预的创伤患者，患者手术量与临床结局之间的关系尚不清楚。研究结果 躯干介入放射学手术量较高的医院与较低的院内死亡率相关。临床意义 集中急诊介入放射学病例、推进创伤护理教育以及提高对介入放射学的认识可带来更好的患者治疗效果。
