Transarterial Embolization for Pediatric Pelvic Fracture Hemorrhage: A National Trauma Data Bank Analysis (2013-2023)

To evaluate outcomes following transarterial embolization (TAE) for pelvic fracture-related hemorrhage in the pediatric population using the National Trauma Data Bank (NTDB).

Pediatric patients (aged ≤18 years) with pelvic fracture-related hemorrhage from the NTDB (2013-2023) were retrospectively identified. Primary endpoints for TAE included hemorrhage control success rate and mortality. Secondary aims included identification of predictors of mortality, characterization of temporal and resource utilization trends in TAE, and comparison of outcomes relative to conservative and surgical management via propensity score-matched analysis.

Among 55,271 pediatric patients with pelvic fracture, 509 underwent TAE, 2,026 underwent surgical intervention, and 558 met conservative criteria. TAE utilization increased by 256% from 2013 to 2023. Clinical success was 97.1% (494/509); mortality was 23.4%. Bilateral and unilateral internal iliac artery embolization demonstrated similar mortality when adjusted for injury severity (odds ratio [OR], 1.32; P = .42). Mortality was associated with higher injury severity score, lower Glasgow coma scale score, and lower initial systolic blood pressure. Transfer and direct admissions had similar mortality (20.0% vs 23.8%, P = .56). In 305 propensity score-matched triplets, TAE (22.3%, 68/305) and surgery (22.6%, 69/305) demonstrated similar mortality (OR, 0.98; 95% CI, 0.66-1.45; P = .92) but significantly higher mortality than conservative management (15.1%, 46/305; OR, 1.61; 95% CI, 1.06-2.44; P = .025). Length of stay and ventilator days were similar, although intensive care unit days trended less with TAE compared with that with surgery.

TAE provides effective hemorrhage control in pediatric pelvic fractures with similar mortality to surgical intervention. Additional research is required to elucidate patient selection and long-term outcomes.