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Immediate Angiography and Decreased In-Hospital Mortality of Adult Trauma Patients: A Nationwide Study

  • Clinical Investigation
  • Embolisation (arterial)
  • Published:
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Abstract

Purpose

This study aimed to elucidate whether immediate angiography within 30 min is associated with lower in-hospital mortality compared with non-immediate angiography.

Materials and Methods

We conducted a retrospective cohort study using a nationwide trauma databank (2019–2020). Adult trauma patients who underwent emergency angiography within 12 h after hospital arrival were included. Patients who underwent surgery before angiography were excluded. Immediate angiography was defined as one performed within 30 min after arrival (door-to-angio time ≤ 30 min). In-hospital mortality and non-operative management (NOM) failure were compared between patients with immediate and non-immediate angiography. Inverse probability weighting with propensity scores was conducted to adjust patient demographics, injury mechanism and severity, vital signs on hospital arrival, and resuscitative procedures. A restricted cubic spline curve was drawn to reveal survival benefits by door-to-angio time.

Results

Among 1,455 patients eligible for this study, 92 underwent immediate angiography. Angiography ≤ 30 min was associated with decreased in-hospital mortality (5.0% vs 11.1%; adjusted odds ratio [OR], 0.42 [95% CI, 0.31–0.56]; p < 0.001), as well as lower frequency of NOM failure: thoracotomy and laparotomy after angiography (0.8% vs. 1.8%; OR, 0.44 [0.22–0.89] and 2.6% vs. 6.5%; OR, 0.38 [0.26–0.56], respectively). The spline curve showed a linear association between increasing mortality and prolonged door-to-angio time in the initial 100 min after arrival.

Conclusion

In trauma patients, immediate angiography ≤ 30 min was associated with lower in-hospital mortality and fewer NOM failures.

Level of Evidence

Level 3b, non randomized controlled cohort/follow up study.

Graphical Abstract

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Acknowledgements

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Funding

There is no funding source in this study.

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Authors and Affiliations

  1. Trauma Service/Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan

    Ryo Yamamoto, Katsuya Maeshima & Junichi Sasaki

  2. Department of Emergency Medicine, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan

    Tomohiro Funabiki

  3. Department of Surgery, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA

    Brian J. Eastridge & Ramon F. Cestero

Authors
  1. Ryo Yamamoto
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  2. Katsuya Maeshima
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  3. Tomohiro Funabiki
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  5. Ramon F. Cestero
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  6. Junichi Sasaki
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Corresponding author

Correspondence to Ryo Yamamoto.

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The authors have no relevant conflicts of interest to disclose.

Ethical Approval

This study was approved by the Institutional Review Board of the Keio University School of Medicine (application number: 20090087). The requirement for informed consent was waived because of the anonymous nature of the data being used.

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Yamamoto, R., Maeshima, K., Funabiki, T. et al. Immediate Angiography and Decreased In-Hospital Mortality of Adult Trauma Patients: A Nationwide Study. Cardiovasc Intervent Radiol 47, 472–480 (2024). https://doi.org/10.1007/s00270-024-03664-6

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  • DOI: https://doi.org/10.1007/s00270-024-03664-6

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