| Autor: |
Eileen M Bulger, Frederick Rivara, Monica S Vavilala, Kathleen M O'Connell, Sarah Kolnik, Khalida Arif, Qian Qiu, Sean Jones, Christopher Ingraham |
| Jazyk: |
angličtina |
| Rok vydání: |
2021 |
| Předmět: |
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| Zdroj: |
Trauma Surgery & Acute Care Open, Vol 6, Iss 1 (2021) |
| Druh dokumentu: |
article |
| ISSN: |
2397-5776 |
| DOI: |
10.1136/tsaco-2020-000663 |
| Popis: |
Background Angioembolization has been the gold standard for management of pelvic arterial bleeding, but applicability has been limited by delays in access at many trauma centers. We hypothesized that a quality improvement program to reduce time to start of angiography would be associated with lower in-hospital mortality in patients with pelvic fractures and shock.Methods Retrospective study of adults with a pelvic fracture and vital signs consistent with shock admitted to a level I trauma center after the initiation of a quality improvement project to reduce the time to angioembolization (2012 to 2016). Time from admission to procedure start for hemorrhage control was examined based on destination and time of day. In-hospital mortality was the primary outcome and was compared with US benchmarks in the literature.Results The study group included 424 patients with a mean Injury Severity Score of 41±14. Of these, 212 (50%) responded to resuscitation and were admitted to the intensive care unit; 143 (34%) patients went directly to interventional radiology (IR) with a median time to start of angiography of 86 minutes (IQR 66 to 116); and 69 (16%) patients went directly to the OR with a median time to start of operation of 52 minutes (IQR 37 to 73). There were no significant differences in time to procedures based on time of day or transfer status. In-hospital mortality for patients in shock on admission was 15%.Discussion Patients with pelvic fracture and hemorrhagic shock, with a median time to angioembolization of |
| Databáze: |
Directory of Open Access Journals |
| Externí odkaz: |
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