Prevalence and risk factors for major arterial bleeding in fragility pelvic fractures in the aging population

Fragility pelvic fractures (FPF) are increasingly common among elderly patients and, despite being caused by low-energy mechanisms, can result in major arterial bleeding (MAB). However, few studies have examined the prevalence and predictors of MAB in this population. This study aimed to evaluate prevalence and potential risk factors associated with MAB in elderly patients with FPF. This retrospective cohort study used data from the Japan Trauma Data Bank. The study included patients (age ≧ 65 years) with FPF between 2010 and 2021, defining FPF as pelvic fractures caused by a ground-level fall. Demographic, comorbidities, and antithrombotic use were analyzed. MAB was operationally defined by the performance of therapeutic angioembolization (TAE). Multivariable logistic regression was performed to identify predictors of MAB and in-hospital mortality. A total of 1,354 patients met inclusion criteria; 80 patients (5.9%) underwent TAE. Compared with the non-MAB group, the MAB group had significantly higher rates of liver disease, cerebral vascular disease, use of antithrombotic agents, systolic blood pressure (SBP) < 90 mmHg, and lower Glasgow Coma Scale scores. A multivariable logistic regression analysis revealed that age (OR 1.04, 95% CI 1.01-1.07), male sex (OR 2.42, 95% CI 1.49-3.93), cerebral vascular disease (OR 2.11, 95% CI 1.21-3.67), liver disease (OR 6.23, 95% CI 2.36-16.40), and SBP < 90 mmHg (OR 5.43, 95% CI 2.96-9.97) were independently associated with MAB. MAB itself was independently associated with higher in-hospital mortality (OR 4.3, 95% CI 2.1-8.9). Notably, 28% of in-hospital deaths occurred within 48 h and 50% within 7 days of admission. Despite their low-energy origin, FPFs can lead to life-threatening hemorrhage requiring invasive hemostatic intervention. A subset of elderly patients-particularly those with comorbidities or hypotension upon admission-are at elevated risk of MAB and poor outcomes. Early recognition and targeted intervention strategies are essential to improve survival in this growing and vulnerable population.