Factors associated with survival in adult trauma patients undergoing angiography with and without embolization across trauma centers in the United States

Abstract

Introduction: Interventional angiography is increasingly utilized in trauma management for various injuries. Despite published guidelines by the Eastern Association for the Surgery of Trauma on the use of angiography, limited data exist on factors associated with outcomes in angiography procedures. This study examines factors associated with survival to hospital discharge in trauma patients undergoing angiography with or without embolization across US trauma centers. Materials and methods: This retrospective observational study used the National Trauma Data Bank 2017 dataset and included adult trauma patients who underwent conventional angiography with or without embolization. A bivariate analysis was done to compare patients’ characteristics by outcome (survived/died), followed by a multivariable logistic regression analysis to determine factors associated with survival to hospital discharge after adjusting for important confounders. Results: In the included sample of 4242 patients, median age was 41 years and male gender was predominant (72.6%). Overall mean time to angiography was 263.77 ± 750.19 min. Factors positively associated with survival included treatment at large facilities with over 401 beds (OR = 2.170; 95% CI, [1.277–3.685]), helicopter ambulance/fixed-wing transport (OR = 1.736; 95% CI, [1.325–2.275]), mild Glasgow Coma Scale (OR = 7.621; 95% CI, [5.868–9.898]) and moderate Glasgow Coma Scale (OR = 3.127; 95% CI, [2.080–4.701]), SBP ≥ 90 (OR = 1.516; 95% CI [1.199–1.916]), and spleen as embolization site (OR = 1.647; 95% CI [1.119–2.423]). Conclusion: This nationwide study identified variables associated with survival in trauma patients who underwent angiography. These variables can serve in creating standardized risk stratification tools that could be incorporated into evidence-based guidelines for angiography candidates. © 2022, The Author(s), under exclusive licence to American Society of Emergency Radiology (ASER).