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Patient Saf Surg. 2019 Jun 20;13:23. doi: 10.1186/s13037-019-0201-9. eCollection 2019.

Variability in the timeliness of interventional radiology availability for angioembolization of hemodynamically unstable pelvic fractures: a prospective survey among U.S. level I trauma centers.

Author information

1
Trauma Research, LLC, 383 Corona St. #319, Denver, CO 80218 USA.
2
2Research Medical Center, 2316 East Meyer Blvd, Kansas City, MO 64132 USA.
3
3University of Connecticut, Hartford Hospital, Hartford, CT 06106 USA.
4
4Swedish Medical Center, 501 E Hampden Ave, Englewood, CO 80113 USA.
5
5Wesley Medical Center, 550 N. Hillside St, Wichita, KS 67214 USA.
6
6St. Anthony's Hospital, 11600 West 2nd Place, Lakewood, CO 80228 USA.
7
7Penrose Hospital, 2222 North Nevada Ave, Colorado Springs, CO 80907 USA.
8
Medical City Plano, 3901 West 15th Street, Plano, TX 75075 USA.

Abstract

Background:

Patients with hemodynamically unstable pelvic fractures have high mortality due to delayed hemorrhage control. We hypothesized that the availability of interventional radiology (IR) for angioembolization may vary in spite of the mandated coverage at US Level I trauma centers, and that the priority treatment sequence would depend on IR availability.

Methods:

This survey was designed to investigate IR availability and pelvic fracture management practices. Six email invitations were sent to 158 trauma medical directors at Level I trauma centers. Participants were allowed to skip questions and irrelevant questions were skipped; therefore, not all questions were answered by all participants. The primary outcome was the priority treatment sequence for hemodynamically unstable pelvic fractures. Predictor variables were arrival times for IR when working off-site and intervention preparation times. Kruskal-Wallis and ordinal logistic regression were used; alpha = 0.05.

Results:

Forty of the 158 trauma medical directors responded to the survey (response rate: 25.3%). Roughly half of participants had 24-h on-site IR coverage, 24% (4/17) of participants reported an arrival time ≥ 31 min when IR was on-call. 46% (17/37) of participants reported an IR procedure setup time of 31-120 min. Arrival time when IR was working off-site, and intervention preparation time did not significantly affect the sequence priority of angioembolization for hemodynamically unstable pelvic fractures.

Conclusions:

Trauma medical directors should review literature and guidelines on time to angioembolization, their arrival times for IR, and their procedural setup times for angioembolization to ensure utilization of angioembolization in an optimal sequence for patient survival.

KEYWORDS:

Angioembolization; Interventional radiology; Pelvic fracture management; Resuscitative endovascular balloon occlusion of the aorta

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

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