Balancing the clock: Time thresholds for angioembolization and patient outcomes in pelvic trauma

Introduction: In the management of patients with pelvic fractures associated with retroperitoneal hemorrhage, prompt angioembolization is typically required to achieve hemostasis. However, not all institutions are equipped to perform this procedure in a timely manner. This study assessed the impact of time to angioembolization on the outcomes of patients with pelvic fractures. We hypothesize that there is a time threshold for the performance of angioembolization, beyond which patient outcomes may worsen. Methods: The trauma registry system was retrospectively queried for patients treated for pelvic fractures from 2020 to 2023. Patients with unstable hemodynamics who underwent immediate treatment without a comprehensive assessment were excluded. A 5-h cutoff was selected for further analysis on the basis of an observed change in the mortality rate at that time point. The mortality rate and incidence of hypotension were compared between patients who underwent angioembolization within the five-hour window and those who underwent the procedure after the five-hour window. A detailed subset analysis was performed for patients who underwent angioembolization within the five-hour window. Furthermore, potential causes for delayed angioembolization were evaluated. Results: A total of 130 patients with pelvic fractures who required angioembolization were included in this study; the mean time to the procedure was 2.9 h. Patients who underwent angioembolization within the five-hour window had a lower mortality rate (10.5 % vs. 25.0 %, p = 0.099). Multivariate logistic regression indicated that undergoing angioembolization more than five hours was associated with increased mortality (odds ratio = 3.881, p = 0.083). Additionally, a greater proportion of patients who underwent delayed angioembolization (beyond the five-hour window) were transferred from local hospitals (N = 62, 47.7 %). Among these transferred patients, the time before arrival at the trauma center was significantly longer than the time after arrival at the trauma center (4.7 vs. 2.0 h, p < 0.001). Conclusion: Angioembolization beyond five hours in normotensive patients presenting to a level I trauma center found to have pelvic fractures with associated retroperitoneal hemorrhage may be associated with worsened outcomes. Early transportation to hospitals with interventional radiology capabilities may be beneficial in this patient group, but a larger, prospective study is needed to confirm these results.