title: Mortality in trauma patients with active arterial bleeding managed by embolization or surgical packing: An observational cohort study of 66 patients.
abstract: OBJECTIVE
  Exsanguination due to coagulopathy and vascular injury is a common cause of death among trauma patients. Arterial injury can be treated either by angiography and embolization or by explorative laparotomy and surgical packing. The purpose of this study was to compare 30-day mortality and blood product consumption in trauma patients with active arterial haemorrhage in the abdominal and/or pelvic region treated with either angiography and embolization or explorative laparotomy and surgical packing.
  
  
  METHODS
  From January 1(st) 2006 to December 31(st) 2011 2,173 patients with an ISS of >9 were admitted to the Trauma Centre of Copenhagen University Hospital, Rigshospitalet, Denmark. Of these, 66 patients met the inclusion criteria: age above 15 years and active arterial haemorrhage from the abdominal and/or pelvic region verified by a CT scan at admission. Gender, age, initial oxygen saturation, pulse rate and respiratory rate, mechanism of injury, ISS, Probability of Survival, treatment modality, 30-day mortality and number and type of blood products applied were retrieved from the TARN database, patient records and the Danish Civil Registration System.
  
  
  RESULTS
  Thirty-one patients received angiography and embolization, and 35 patients underwent exploratory laparotomy and surgical packing. Gender, age, initial oxygen saturation, pulse rate and respiratory rate, ISS and Probability of Survival were comparable in the two groups.
  
  
  CONCLUSIONS
  A significant increased risk of 30-day mortality (P = 0.04) was found in patients with active bleeding treated with explorative laparotomy and surgical packing compared to angiography and embolization when data was adjusted for age and ISS. No statistical significant difference (P > 0.05) was found in number of transfused blood products applied in the two groups of patients.
authors: Department of Orthopaedic Surgery, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors: Lonnie
authors: L
authors: Froberg
authors: Department of Surgical Gastroenterology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors: Frederik
authors: F
authors: Helgstrand
authors: Department of Radiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors: Caroline
authors: C
authors: Clausen
authors: Department of Anesthesiology, Trauma Center, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors: Jacob
authors: J
authors: Steinmetz
authors: Department of Orthopaedic Surgery, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
authors: Henrik
authors: H
authors: Eckardt
keywords: Embolization; outcome; surgical packing; uncontrolled bleeding