Abstract No. 637 Implementation of American College of Surgeons Committee on Trauma guidelines for interventional radiology: a retrospective review of prospective data compared with historic cohort

Abstract

The American College of Surgeons Committee on Trauma (ACS-COT) recommends that an interventional radiologist (IR) be available within 30 minutes to perform procedures in all designated Level 1 and Level 2 trauma centers but does not require an in-house IR service. Several studies have observed that delays in IR response times are linked to poor patient outcomes. The purpose of this study was to evaluate the overall feasability and patient outcomes associated with a prospective continuous quality improvement (QI) process that was enacted to meet the ACS-COT criterion for angioembolization. A QI process was established at our institution to increase compliance with the ACS-COT criterion by establishing clearly defined indications for IR trauma activation. In addition, a simplified, reproducible and measurable workflow for electronic recording of response times was adopted. We reviewed 110 acute trauma patients for whom Level 1 activation for angioembolization was initiated between April 2015 and March 2019. The prospective cohort (n = 58) was collected after QI changes were enacted in April 2017. The prospective and retrospective cohorts were comparable with no statistical difference in demographic data, ISS scores and anatomical location of bleeding (pelvic vs. non-pelvic vascular). Median IR response time in the prospective group was 28.5 minutes (IQR 15,41), and 40/58 (69%) were compliant with the ACS-COT criteria of being available to perform procedure within 30 minutes. Median activation to procedure start time was 72 minutes in the prospective group and 183 minutes in the retrospective (P <0.001). In the prospective group, 40/58 patients (69%) underwent an embolization procedure, while in the retrospective group, 23/52 (44.2%) underwent an embolization procedure (P = 0.007). No significant difference was observed in the mortality rates or the hospital length of stay between the two groups. It is possible to meet the ACS-COT criteria for IR responses by establishing strict resource utilization parameters.