Angioembolization versus surgical repair in pediatric liver trauma: A propensity score-matched analysis of TQIP data.

BACKGROUND

Liver trauma is a leading cause of pediatric mortality, yet consensus on optimal intervention in children remains unclear. Angioembolization (AE), widely adopted in adults, remains underutilized in children. We hypothesized that AE would be associated with lower in-hospital mortality than surgical repair (SR).

METHODS

We conducted a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database (2018-2021) to identify pediatric patients (<18 years) with liver trauma undergoing AE or SR (N = 817). The primary outcome was in-hospital mortality; secondary outcomes included discharge disposition, ICU/hospital length of stay, early blood product use, and complications. One-to-one propensity score matching and multivariable logistic regression adjusted for confounding.

RESULTS

In the matched cohort, AE (N = 152) was associated with lower mortality (7.2 % vs 19.1 %; p = 0.002) than SR (N = 152). AE patients were more often discharged home (68.4 % vs 40.1 %; p < 0.001) and required fewer transfusions within 4 h: packed red blood cells (56.5 % vs 77.3 %; p < 0.001), plasma (39.5 % vs 67.8 %; p < 0.001), and platelets (19.7 % vs 50.7 %; p < 0.001). In multivariate analysis, AE remained independently associated with reduced mortality (OR = 0.34, 95 % CI 0.15-0.73; p = 0.01), with Injury Severity Score (ISS) predicting mortality (OR = 1.06, 95 % CI 1.03-1.10; p < 0.01). Age, sex, and penetrating injury were not significant predictors (AUC = 0.791).

CONCLUSION

AE was associated with lower in-hospital mortality and reduced blood product requirements compared to SR in select pediatric liver trauma patients, suggesting that AE may be an effective adjunct to nonoperative management in hemodynamically stable patients.