Pelvic embolization in severely traumatized patients in hemorrhagic shock with pelvic fractures without contrast extravasation on the initial CT scan: A retrospective comparative study between three French centers

INTRODUCTION: Pelvic fractures complicated by hemorrhagic shock represent a major challenge in trauma management, particularly in the absence of active arterial bleeding (e.g., contrast extravasation or "blush") on computed tomography (CT). In this context, some teams advocate for non-selective arterial embolization, whereas others favor a watchful waiting strategy. The aim of this study was to compare, in patients with severe pelvic trauma and hemorrhagic shock, the impact of two strategies (i.e., non-interventional management versus systematic embolization) on red blood cell transfusion requirements within the first 24 h following admission. MATERIALS AND METHODS: This multicenter retrospective cohort study included adult patients (≥18 years) admitted to the trauma resuscitation unit of three level-1 trauma centers. Patients were included in the study if they received at least two units of packed red blood cells (PRBCs) within 4 h of admission and if they had surrogates of shock (a lactate level > 5 mmol/L at admission or if they required vasopressor support within 4 h of injury). The exclusion criterion was the presence of arterial contrast extravasation ("blush") on CT. The primary outcome was the number of PRBC units transfused within the first 24 h. Secondary outcomes included 48-hour mortality, 30-day mortality, length of stay in the intensive care unit, total hospital length of stay, and duration of vasopressor therapy. RESULTS: A total of 165 patients were included between January 2015 and September 2022. In multivariable analysis, no significant difference was observed in the median number of PRBC units transfused within 24 h between the two strategies (3.0 [2.0; 6.5] vs. 3.0 [2.0;4.0]; p = 0.872). Similarly, no difference in 30-day mortality was identified (odds ratio 0.62, 95% confidence interval 0.25-1.67; p = 0.310). No significant differences were found in the duration of shock, vasopressor support, or early mortality. CONCLUSION: In patients with pelvic fractures complicated by hemorrhagic shock and without evidence of active arterial bleeding on CT, this study did not demonstrate the superiority of systematic embolization over a non-interventional management in terms of transfusion requirements or clinical outcomes.