Comparison between laparotomy first versus angiographic embolization first in patients with
pelvic fracture and hemoperitoneum: a nationwide observational study from the Japan Trauma Data
Bank
Sammanfattning
Background
A common dilemma in the management of pelvic fractures is recognizing the presence of associated
abdominal injury. The purpose of this study was to determine the association between initial
therapeutic intervention (laparotomy or transcatheter arterial embolization (TAE)) and mortality.
Methods
This was a cohort study using the Japan Trauma Data Bank between 2004 and 2010, including blunt
trauma patients with pelvic fractures and positive Focused Assessment with Sonography in Trauma
(FAST) results. Eligible patients were restricted to those who underwent laparotomy or
TAE/angiography as the initial therapeutic intervention. Crude and adjusted odds ratio (AOR) for in-
hospital mortality were compared between the laparotomy first and TAE first groups (reference group).
Multiple logistic regression analysis and propensity score adjusted analysis were used to adjust for
clinically relevant confounders, including the severity of injury.
Results
Of the 317 participants, 123 patients underwent laparotomy first and 194 patients underwent TAE first.
The two groups were similar in terms of age, although the laparotomy first group had higher mean
Injury Severity Scores (ISS) and higher mean scores based on the abdominal Abbreviated Injury
Scale (AIS), as well as lower mean pelvic AIS and systolic blood pressure (SBP). Half of the patients
who were hypotensive (SBP < 90 mmHg) on arrival underwent TAE first. The laparotomy first group
had a significantly higher crude in-hospital mortality (41% vs. 27%; P < 0.01). After adjusting for
confounders, the choice of initial therapeutic intervention did not affect the in-hospital mortality (AOR,
1.20; 95% Confidence Interval (CI), 0.61-2.39). Even in the limited subgroup of hypotensive patients
(SBP 66–89 mmHg and SBP < 65 mmHg subgroup), the effect was similar (AOR, 1.50; 95% CI, 0.56-
4.05 and AOR, 1.05; 95% CI, 0.44-3.03).
Conclusions
In Japan, laparotomy and TAE are equally chosen as the initial therapeutic intervention regardless of
hemodynamic status. No significant difference was seen between the laparotomy first and TAE first
groups regarding in-hospital mortality.