Abstract
Introduction
Management of hemorrhage from pelvic fractures is complex and requires multidisciplinary
attention. Pelvic angioembolization (AE) has become a key intervention to aid in obtaining
definitive hemorrhage control. We hypothesized that pelvic AE would be associated
with an increased risk of venous thromboembolism (VTE).
Methods
All adults (age >16) with a severe pelvic fracture (Abbreviated Injury Scale ≥ 4)
secondary to a blunt traumatic mechanism in the 2017-2019 American College of Surgeons
Trauma Quality Improvement Program database were included. Patients who did not receive
VTE prophylaxis during their admission were excluded. Patients who underwent pelvic
AE during the first 24 h of admission were compared to those who did not using propensity
score matching. Matching was performed based on patient demographics, admission physiology,
comorbidities, injury severity, associated injuries, other hemorrhage control procedures,
and VTE prophylaxis type, and time to initiation of VTE prophylaxis. The rates of
VTE (deep vein thrombosis and pulmonary embolism) were compared between the matched
groups.
Results
Of 72,985 patients with a severe blunt pelvic fracture, 1887 (2.6%) underwent pelvic
AE during the first 24 h of admission versus 71,098 (97.4%) who did not. Pelvic AE patients had a higher median Injury Severity
Score and more often required other hemorrhage control procedures, with laparotomy
being most common (24.7%). The median time to initiation of VTE prophylaxis in pelvic
AE versus no pelvic AE patients was 60.1 h (interquartile range = 36.6-98.6) versus 27.7 h (interquartile range = 13.9-52.4), respectively. After propensity score matching,
pelvic AE patients were more likely to develop VTE compared to no pelvic AE patients
(11.8% versus 9.5%, P = 0.03).
Conclusions
Pelvic AE for control of hemorrhage from severe pelvic fractures is associated with
an increased risk of in-hospital VTE. Patients who undergo pelvic AE are especially
high risk for VTE and should be started as early as safely possible on VTE prophylaxis.
Keywords
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Article info
Publication history
Published online: November 25, 2022
Accepted:
October 24,
2022
Received in revised form:
October 22,
2022
Received:
May 19,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
