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Effect of door-to-angioembolization time on mortality in pelvic fracture

Every hour of delay counts

Matsushima, Kazuhide, MD; Piccinini, Alice, MD; Schellenberg, Morgan, MD, MPH; Cheng, Vincent, MD; Heindel, Patrick; Strumwasser, Aaron, MD; Benjamin, Elizabeth, MD, PhD; Inaba, Kenji, MD; Demetriades, Demetrios, MD, PhD

Journal of Trauma and Acute Care Surgery: May 2018 - Volume 84 - Issue 5 - p 685–692
doi: 10.1097/TA.0000000000001803
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INTRODUCTION Angioembolization (AE) is widely used for hemorrhagic control in patients with pelvic fracture. The latest version of the Resources for Optimal Care of the Injured Patient issued by the American College of Surgeons Committee on Trauma requires interventional radiologists to be available within 30 minutes to perform an emergency AE. However, the impact of time-to-AE on patient outcomes remains unknown. We hypothesized that a longer time-to-AE would be significantly associated with increased mortality in patients with pelvic fracture.

METHODS This is a 2-year retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database from January 2013 to December 2014. We included adult patients (age ≥ 18 years) with blunt pelvic fracture who underwent pelvic AE within 4 hours of hospital admission. Patients who required any hemorrhage control surgery for associated injuries within 4 hours were excluded. Hierarchical logistic regression was performed to evaluate the impact of time-to-AE on in-hospital and 24-hour mortality.

RESULTS A total of 181 patients were included for analysis. The median age was 54 years (interquartile range, 38–68) and 69.6% were male. The median injury severity score was 34 (interquartile range, 27–43). Overall in-hospital mortality rate was 21.0%. The median packed red blood cell transfusions within 4 and 24 hours after admission were 4 and 6 units, respectively. After adjusting for other covariates in a hierarchical logistic regression model, a longer time-to-pelvic AE was significantly associated with increased in-hospital mortality (odds ratio, 1.79 for each hour; 95% confidence interval, 1.11–2.91; p = 0.018).

CONCLUSION The current study showed an increased risk of in-hospital mortality related to a prolonged time-to-AE for hemorrhagic control following pelvic fractures. Our results suggest that all trauma centers should allocate resources to minimize delays in performing pelvic AE.

LEVEL OF EVIDENCE Therapeutic/care management, level IV.

From the Division of Acute Care Surgery, University of Southern California, Los Angeles, California (K.M., A.P., M.S., V.C., P.H., A.S., E.B., K.I., D.D.).

Submitted: August 29, 2017, Revised: December 1, 2017, Accepted: January 4, 2018, Published online: January 25, 2018.

This paper was presented at 76th Annual Meeting of the American Association for Surgery of Trauma and Clinical Congress of Acute Care Surgery, September 15, 2017, Baltimore, Maryland.

Address for reprints: Kazuhide Matsushima, MD, Assistant Professor of Surgery, University of Southern California, LAC + USC Medical Center, Inpatient Tower (C), 2051 Marengo St, C5L100, Los Angeles, CA 90033; email: kazuhide.matsushima@med.usc.edu.

© 2018 Lippincott Williams & Wilkins, Inc.