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Angioembolization versus surgical repair in pediatric liver trauma: A propensity score-matched analysis of TQIP data
Zihuang Zhang1, Xingruo Zhang2, Daniel Tahan1
1Tulane University School of Medicine, Department of Surgery, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
Insights
Angioembolization (AE) shows lower mortality for pediatric liver trauma than surgical repair (SR). AE also reduced blood product needs, suggesting its effectiveness in stable patients.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Interventional Radiology
Background:
- Pediatric liver trauma is a significant cause of mortality.
- Optimal treatment strategies for pediatric liver trauma lack consensus.
- Angioembolization (AE) is underutilized in children compared to adults.
Purpose of the Study:
- To compare the effectiveness of angioembolization (AE) versus surgical repair (SR) in pediatric liver trauma.
- To investigate AE's association with in-hospital mortality and resource utilization.
- To evaluate AE as an alternative to surgical repair in pediatric liver trauma management.
Main Methods:
- Retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database (2018-2021).
- Identified pediatric patients (<18 years) with liver trauma undergoing AE or SR (N=817).
- Utilized propensity score matching and multivariable logistic regression to adjust for confounding factors.
Main Results:
- Angioembolization (AE) was associated with significantly lower in-hospital mortality (7.2% vs. 19.1%; p=0.002) compared to surgical repair (SR).
- AE patients had higher rates of discharge home (68.4% vs. 40.1%; p<0.001) and required fewer blood product transfusions.
- Multivariable analysis confirmed AE independently associated with reduced mortality (OR=0.34; p=0.01), with Injury Severity Score (ISS) as a predictor.
Conclusions:
- Angioembolization (AE) demonstrates superior outcomes compared to surgical repair (SR) in select pediatric liver trauma cases.
- AE is linked to decreased in-hospital mortality and reduced need for early blood product transfusions.
- AE may serve as an effective nonoperative management adjunct for hemodynamically stable pediatric liver trauma patients.
Background:
Liver trauma is a leading cause of pediatric mortality, yet consensus on optimal intervention in children remains unclear. Angioembolization (AE), widely adopted in adults, remains underutilized in children. We hypothesized that AE would be associated with lower in-hospital mortality than surgical repair (SR).
Methods:
We conducted a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database (2018-2021) to identify pediatric patients (<18 years) with liver trauma undergoing AE or SR (N = 817). The primary outcome was in-hospital mortality; secondary outcomes included discharge disposition, ICU/hospital length of stay, early blood product use, and complications. One-to-one propensity score matching and multivariable logistic regression adjusted for confounding.
Results:
In the matched cohort, AE (N = 152) was associated with lower mortality (7.2 % vs 19.1 %; p = 0.002) than SR (N = 152). AE patients were more often discharged home (68.4 % vs 40.1 %; p < 0.001) and required fewer transfusions within 4 h: packed red blood cells (56.5 % vs 77.3 %; p < 0.001), plasma (39.5 % vs 67.8 %; p < 0.001), and platelets (19.7 % vs 50.7 %; p < 0.001). In multivariate analysis, AE remained independently associated with reduced mortality (OR = 0.34, 95 % CI 0.15-0.73; p = 0.01), with Injury Severity Score (ISS) predicting mortality (OR = 1.06, 95 % CI 1.03-1.10; p < 0.01). Age, sex, and penetrating injury were not significant predictors (AUC = 0.791).
Conclusion:
AE was associated with lower in-hospital mortality and reduced blood product requirements compared to SR in select pediatric liver trauma patients, suggesting that AE may be an effective adjunct to nonoperative management in hemodynamically stable patients.
