Abstract
BackgroundPatients 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.MethodsThis 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.ResultsForty 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.ConclusionsTrauma 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.
Highlights
Patients with hemodynamically unstable pelvic fractures have high mortality due to delayed hemorrhage control
No pelvic fracture protocol was implemented at 28% (11/40) of participating Level I trauma centers (Table 1)
We failed to reject the null hypotheses; interventional radiology (IR) availability was variable across Level I trauma centers and did not significantly affect the priority treatment sequence of angioembolization
Summary
Patients with hemodynamically unstable pelvic fractures have high mortality due to delayed hemorrhage control. Pelvic fracture management is one of the most complex treatment strategies [1]. Published guidelines offer varying approaches to care for hemodynamically unstable pelvic fractures [2,3,4,5,6]. The World Society of Emergency Surgeons (WSES) and Western Trauma Association (WTA) recommend selective angioembolization after pelvic packing [2, 3]. Trauma Quality Improvement Program (TQIP) [4] utilizes angioembolization after external fixation and pelvic packing, or last when in extremis. There remains a high level of ambiguity on the optimal management of patients with hemodynamic unstable pelvic fractures across guidelines [2,3,4,5,6]
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