From the Division of Acute Care Surgery, University of Southern California, Los Angeles, California (K.M., A.P., M.S., V.C., P.H., A.S., E.B., K.I., D.D.).
J Trauma Acute Care Surg. 2018 May;84(5):685-692. doi: 10.1097/TA.0000000000001803.
Angioembolization (AE) is widely used for hemorrhagic control in patients with pelvic fracture. The latest version of the Resources for Optimal Care of the Injured Patient issued by the American College of Surgeons Committee on Trauma requires interventional radiologists to be available within 30 minutes to perform an emergency AE. However, the impact of time-to-AE on patient outcomes remains unknown. We hypothesized that a longer time-to-AE would be significantly associated with increased mortality in patients with pelvic fracture.
This is a 2-year retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database from January 2013 to December 2014. We included adult patients (age ≥ 18 years) with blunt pelvic fracture who underwent pelvic AE within 4 hours of hospital admission. Patients who required any hemorrhage control surgery for associated injuries within 4 hours were excluded. Hierarchical logistic regression was performed to evaluate the impact of time-to-AE on in-hospital and 24-hour mortality.
A total of 181 patients were included for analysis. The median age was 54 years (interquartile range, 38-68) and 69.6% were male. The median injury severity score was 34 (interquartile range, 27-43). Overall in-hospital mortality rate was 21.0%. The median packed red blood cell transfusions within 4 and 24 hours after admission were 4 and 6 units, respectively. After adjusting for other covariates in a hierarchical logistic regression model, a longer time-to-pelvic AE was significantly associated with increased in-hospital mortality (odds ratio, 1.79 for each hour; 95% confidence interval, 1.11-2.91; p = 0.018).
The current study showed an increased risk of in-hospital mortality related to a prolonged time-to-AE for hemorrhagic control following pelvic fractures. Our results suggest that all trauma centers should allocate resources to minimize delays in performing pelvic AE.
Therapeutic/care management, level IV.
血管栓塞术（AE）广泛应用于骨盆骨折患者的出血控制。美国外科医师学院创伤委员会发布的最新版《优化创伤患者治疗资源》要求介入放射科医生在 30 分钟内能够进行紧急 AE。然而，AE 时间对患者结局的影响尚不清楚。我们假设，AE 时间延长与骨盆骨折患者的死亡率增加显著相关。
这是一项为期 2 年的回顾性队列研究，使用了美国外科医师学院创伤质量改进计划数据库，时间范围为 2013 年 1 月至 2014 年 12 月。我们纳入了在入院后 4 小时内行骨盆 AE 的成年（年龄≥18 岁）钝性骨盆骨折患者。在 4 小时内行任何相关损伤出血控制手术的患者被排除在外。采用分层逻辑回归评估 AE 时间对住院期间和 24 小时死亡率的影响。
共纳入 181 例患者进行分析。中位年龄为 54 岁（四分位间距，38-68），69.6%为男性。损伤严重程度评分中位数为 34（四分位间距，27-43）。总体住院死亡率为 21.0%。入院后 4 小时和 24 小时内的中位红细胞悬液输注量分别为 4 单位和 6 单位。在分层逻辑回归模型中调整其他协变量后，AE 时间延长与住院期间死亡率增加显著相关（每小时的比值比为 1.79；95%置信区间，1.11-2.91；p=0.018）。
本研究显示，与骨盆骨折后出血控制的 AE 时间延长相关的住院期间死亡风险增加。我们的结果表明，所有创伤中心都应分配资源，以尽量减少行骨盆 AE 的延迟。
治疗/护理管理，IV 级。
