A short decision time for transcatheter embolization can better predict mortality in patients with pelvic fracture

Abstract Purpose: Early use of hemostasis strategies, such as transcatheter arterial embolization (TAE), is critical in cases of pelvic injury because of the risk of hemorrhagic shock and other fatal injuries. We investigated the influence of delays in TAE administration on mortality.Methods: This retrospective, observational study enrolled patients with pelvic injury who underwent acute TAE and were admitted to the Advanced Critical Care Center at Gifu University Hospital between January 2008 and December 2019. The time from when the doctor decided to administer TAE to the start of TAE (needling time) was defined as “decision-TAE time.”Results: We included 159 patients. The median decision-TAE time was 60 min. Twenty-four patients died. Kaplan–Meier curves for overall survival were compared between patients above and below the median cutoff value for decision-TAE time; survival was significantly better for patients below the median cutoff value (p=0.02). Multivariable Cox proportional hazards regression analysis revealed that the longer the decision-TAE time, the higher the risk of mortality (p=0.037). A short TAE duration (procedure time) with a short decision-TAE time was associated with the best survival (p for interaction=0.023).Conclusions: Decision-TAE time may play a key role in establishing resuscitation in pelvic fracture patients, and efforts to shorten this time should be pursued.