TAE for Pediatric Pelvic Fracture Hemorrhage Matches Surgical Mortality, Use Tripled Over a Decade

In 509 pediatric patients from a 10-yr national registry, transcatheter arterial embolization achieved 97.1% hemorrhage control with mortality similar to surgery (22.3% vs 22.6%; OR 0.98, 95% CI 0.66–1.45). TAE use rose 256% 2013–2023. Conservative-managed patients had lower mor…

• Retrospective NTDB analysis (2013–2023); 55,271 pediatric pelvic fracture patients identified; 509 received TAE, 2,026 surgery, 558 managed conservatively; propensity-matched triplets (n=305 per arm) used for mortality comparison.
• In propensity-matched analysis, both TAE and surgery carried significantly higher mortality than conservative management (OR 1.61, 95% CI 1.06–2.44; P=0.025), almost certainly reflecting case-mix severity rather than a causal harm of intervention; bilateral vs. unilateral internal iliac embolization showed no mortality difference (OR 1.32, P=0.42).
• Key limitation: retrospective administrative database with inherent selection bias — patients selected for TAE or surgery were substantially more severely injured than conservatively managed patients, limiting causal inference; long-term outcomes and detailed injury-pattern data unavailable from NTDB.

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