Transcatheter Arterial Embolization versus Open Surgery for Blunt Abdominal Solid Organ Injury with Traumatic Brain Injury: A Retrospective Cohort Study

This retrospective observational study compared the outcomes of transcatheter arterial embolization (TAE) versus open surgery in patients with blunt abdominal solid organ injury (liver, spleen, or kidney; abdominal Abbreviated Injury Scale [AIS] ≥ 3) with traumatic brain injury (TBI) (head AIS ≥ 3), using data from the Japan Trauma Data Bank (2004–2019). Patient characteristics were adjusted using propensity score matching. The primary endpoint was in-hospital mortality; secondary endpoints included 48-h mortality, transfusion requirements, and complications. After matching, 134 patients per group were analyzed. In-hospital mortality was significantly lower in the TAE group (25/134 [18.7%] vs. 41/134 [30.6%], adjusted odds ratio [AOR] 0.287, 95% confidence interval, 0.124–0.662, p  = 0.003). TAE also showed lower 48-h mortality (11/134 [8.2%] vs. 21/134 [15.7%], p  = 0.026) and transfusion rates. Complication rates were similar. Subgroup analysis showed that TAE was superior in non-shock (AOR 0.397, p  = 0.036), elderly (AOR 0.305, p  = 0.044), and focal TBI patients (AOR 0.319, p  = 0.007) but not in patients with diffuse TBI. TAE was associated with more favorable treatment outcomes than open surgery in patients with blunt abdominal solid organ injury complicated by TBI. TAE may be a feasible option for abdominal organ injury with TBI, particularly in non-shock, elderly, and focal TBI patients.