Ann Surg. 2019 Oct;270(4):612-619. doi: 10.1097/SLA.0000000000003486.
The aim of this study was to evaluate the effect of a recently active endovascular trauma service (ETS) on case volume and time to hemostasis, as a complement to an existing interventional radiology (IR) service.
Endovascular techniques are vital for trauma care, but timely access can be a challenge. There is a paucity of data on the effect of a multispecialty team for delivery of endovascular hemorrhage control.
The electronic medical record of trauma patients undergoing endovascular procedures between 2013 and 2018 was queried for provider type (IR or ETS). Case volume and rates were expressed per 100 monthly admissions, normalizing for seasonal variation. Interrupted time series analysis was used to model the case rate pre- and post-introduction of the ETS. Admission-to-procedure-time data were collected for pelvic angioembolization as a marker of patients requiring emergency hemostasis.
During 6 years, 1274 admission episodes required endovascular interventions. Overall case volume increased from 2.7 to 3.6 at a rate of 0.006 (P = 0.734) after introduction of the ETS. IR case volume decreased from 3.3 to 2.6 at a rate of 0.03 (P = 0.063). ETS case volume increased at a rate of 0.048 (P < 0.001), which was significantly different from the IR trend (P < 0.001). Median (interquartile range) time-to-procedure (hours) was significantly shorter for pelvic angioembolization [3.0 (4.4) vs 4.3 (3.6); P < 0.001] when ETS was compared to IR.
A surgical ETS increases case volume and decreases time to hemostasis for trauma patients requiring time sensitive interventions. Further work is required to assess patient outcome following this change.
本研究旨在评估最近开展的血管内创伤服务（ETS）对病例数量和止血时间的影响，作为现有介入放射学（IR）服务的补充。
血管内技术对创伤救治至关重要，但及时获得这些技术可能具有挑战性。关于多学科团队提供血管内出血控制的效果的数据很少。
查询了 2013 年至 2018 年间接受血管内手术的创伤患者的电子病历，以了解提供者类型（IR 或 ETS）。通过每月入院人数的比例（考虑季节性变化进行标准化）来表示病例数量和发生率。采用中断时间序列分析来对 ETS 引入前后的病例发生率进行建模。收集骨盆血管栓塞术的入院至手术时间数据，作为需要紧急止血的患者的标志物。
在 6 年期间，1274 例入院病例需要进行血管内介入治疗。总体病例数量从 ETS 引入前的 2.7 例增加到引入后的 3.6 例，增长率为 0.006（P = 0.734）。IR 病例数量从 3.3 例减少到 2.6 例，下降率为 0.03（P = 0.063）。ETS 病例数量的增长率为 0.048（P < 0.001），与 IR 趋势明显不同（P < 0.001）。与 IR 相比，ETS 时骨盆血管栓塞术的中位（四分位距）手术时间[3.0（4.4）小时比 4.3（3.6）小时；P < 0.001]显著缩短。
外科 ETS 增加了需要时间敏感干预的创伤患者的病例数量，并缩短了止血时间。需要进一步研究以评估这一变化对患者结局的影响。
