Abstract
BackgroundMost guidelines recommend both pelvic packing (PP) and angioembolization for hemodynamically unstable pelvic fractures, however their sequence varies. Some argue to use PP first because orthopaedic surgeons are more available than interventional radiologists; however, there is no data confirming this.MethodsThis cross-sectional survey of 158 trauma medical directors at US Level I trauma centers collected the availability of orthopaedic surgeons and interventional radiologists, the number of orthopaedic trauma surgeons trained to manage pelvic fractures, and priority treatment sequence for hemodynamically unstable pelvic fractures. The study objective was to compare the availability of orthopaedic surgeons to interventional radiologists and describe how the availability of orthopaedic surgeons and interventional radiologists affects the treatment sequence for hemodynamically unstable pelvic fractures. Fisher’s exact, chi-squared, and Kruskal-Wallis tests were used, alpha = 0.05.ResultsThe response rate was 25% (40/158). Orthopaedic surgeons (86%) were on-site more often than interventional radiologists (54%), p = 0.003. Orthopaedic surgeons were faster to arrive 39% of the time, and interventional radiologists were faster to arrive 6% of the time. There was a higher proportion of participants who prioritized PP before angioembolization at centers with above the average number (> 3) of orthopaedic trauma surgeons trained to manage pelvic fractures, as among centers with equal to or below average, p = 0.02. Arrival times for orthopaedic surgeons did not significantly predict prioritization of angioembolization or PP.ConclusionsOur results provide evidence that orthopaedic surgeons typically are more available than interventional radiologists but contrary to anecdotal evidence most participants used angioembolization first. Familiarity with the availability of orthopaedic surgeons and interventional radiologists may contribute to individual trauma center’s treatment sequence.
Highlights
Mortality rates for patients with hemodynamically unstable pelvic fractures have been reported to be as high as 40% [1]
We previously reported that 46% of participating Level I trauma centers indicated intervention preparation times between 31 and 120 min [12], whereas the American College of Surgeons (ACS) guidelines require Level I trauma centers to have an operating rooms promptly available to allow for emergency operations on musculoskeletal injuries, such as pelvic fractures [11]
Despite this and contrary to anecdotal evidence that pelvic packing (PP) would be utilized before angioembolization due to the availability of orthopaedic surgeons, there was a lack of association between the prioritization of PP over angioembolization and who was faster to arrive: interventional radiologists or orthopaedic surgeons
Summary
Mortality rates for patients with hemodynamically unstable pelvic fractures have been reported to be as high as 40% [1]. There have been no studies that compared the availability of orthopaedic surgeons to the availability of interventional radiologists to treat patients with hemodynamically unstable pelvic fractures; this data could contribute to the development of the optimal guideline on the use PP or angioembolization first, as a shorter time to hemorrhage control can improve outcomes. Most guidelines recommend both pelvic packing (PP) and angioembolization for hemodynamically unstable pelvic fractures, their sequence varies. Some argue to use PP first because orthopaedic surgeons are more available than interventional radiologists; there is no data confirming this
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