Role of Angiographic Intervention among Patients with Acute Traumatic Hemorrhage: Insights from the National Trauma Data Bank

Abstract Purpose: The management of trauma patients has evolved in recent decades, with endovascular techniques including angiography, embolization, filter placement, and resuscitative balloon occlusion. Few studies have utilized a national trauma database to understand the magnitude of this practice at a national population-based level. Herein, the objective is to understand the utilization and effect of interventional radiology (IR) treatment on hemodynamically unstable trauma patients in the National Trauma Data Bank (NTDB). Methods: The NTDB was queried from 2013 to 2023 for patients who received packed red blood cells or whole blood within 4 h after arrival. Patients with trauma to the abdomen, extremities, and thorax were included. IR intervention was identified as those who underwent angioembolization and angiography with stenting, while angiography only and no angiography were considered “no IR intervention.” Multivariable Cox proportional hazard regression was conducted to assess the effect of IR intervention in the cohort, and subgroup analysis was done in the setting of nonoperative (nonsurgical) and operative (surgical) management. Results: Totally 322,205 patients were identified in the database; 28,409 (8.8%) underwent IR intervention. Most patients were nonoperative with no IR intervention ( n = 150,374; 47%), while 122,551 (38.5%) underwent surgical intervention without IR intervention, and 27,478 (8.6%) underwent IR intervention without surgical intervention. Overall, IR intervention was associated with a lower risk of mortality compared to no intervention (hazard ratio [HR]: 0.87; P < 0.001). Subgroup analysis among nonsurgical patients demonstrated that IR intervention was associated with a lower risk of mortality (HR: 0.70; P < 0.001). Among surgical patients, IR intervention was associated with a similar risk of mortality (HR: 0.96; P = 0.20). Conclusion: IR was associated with lower mortality risk compared to no IR intervention. This result remained with propensity-weighted analysis for nonoperative patients and suggests the overall positive impact of IR-related embolization and/or stenting. This study demonstrated that IR intervention may be beneficial for hemorrhaging patients and that interventional radiologists must be an integral part of the discussion regarding trauma protocols to support a multidisciplinary approach.