Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon.
Emerg Radiol. 2023 Feb;30(1):1-10. doi: 10.1007/s10140-022-02094-6. Epub 2022 Oct 20.
Interventional angiography is increasingly utilized in trauma management for various injuries. Despite published guidelines by the Eastern Association for the Surgery of Trauma on the use of angiography, limited data exist on factors associated with outcomes in angiography procedures. This study examines factors associated with survival to hospital discharge in trauma patients undergoing angiography with or without embolization across US trauma centers.
This retrospective observational study used the National Trauma Data Bank 2017 dataset and included adult trauma patients who underwent conventional angiography with or without embolization. A bivariate analysis was done to compare patients' characteristics by outcome (survived/died), followed by a multivariable logistic regression analysis to determine factors associated with survival to hospital discharge after adjusting for important confounders.
In the included sample of 4242 patients, median age was 41 years and male gender was predominant (72.6%). Overall mean time to angiography was 263.77 ± 750.19 min. Factors positively associated with survival included treatment at large facilities with over 401 beds (OR = 2.170; 95% CI, [1.277-3.685]), helicopter ambulance/fixed-wing transport (OR = 1.736; 95% CI, [1.325-2.275]), mild Glasgow Coma Scale (OR = 7.621; 95% CI, [5.868-9.898]) and moderate Glasgow Coma Scale (OR = 3.127; 95% CI, [2.080-4.701]), SBP ≥ 90 (OR = 1.516; 95% CI [1.199-1.916]), and spleen as embolization site (OR = 1.647; 95% CI [1.119-2.423]).
This nationwide study identified variables associated with survival in trauma patients who underwent angiography. These variables can serve in creating standardized risk stratification tools that could be incorporated into evidence-based guidelines for angiography candidates.
介入血管造影术在各种创伤的治疗中越来越多地被应用。尽管东部创伤外科学会(Eastern Association for the Surgery of Trauma)发布了关于血管造影术使用的指南，但关于血管造影术相关结果的影响因素的数据有限。本研究在美国创伤中心调查了接受血管造影术（有或无栓塞）的创伤患者与生存至出院相关的因素。
本回顾性观察性研究使用了国家创伤数据库 2017 年数据集，纳入了接受常规血管造影术（有或无栓塞）的成年创伤患者。通过双变量分析比较了不同结局（存活/死亡）患者的特征，然后进行多变量逻辑回归分析，以确定在调整重要混杂因素后与生存至出院相关的因素。
在纳入的 4242 例患者样本中，中位年龄为 41 岁，男性占主导地位（72.6%）。总体平均血管造影时间为 263.77±750.19 分钟。与生存相关的因素包括在床位超过 401 张的大型医疗机构治疗（OR=2.170；95%CI，[1.277-3.685]）、直升机救护车/固定翼运输（OR=1.736；95%CI，[1.325-2.275]）、轻度格拉斯哥昏迷量表（OR=7.621；95%CI，[5.868-9.898]）和中度格拉斯哥昏迷量表（OR=3.127；95%CI，[2.080-4.701]）、收缩压≥90mmHg（OR=1.516；95%CI，[1.199-1.916]）和栓塞部位为脾脏（OR=1.647；95%CI，[1.119-2.423]）。
这项全国性研究确定了与接受血管造影术的创伤患者生存相关的变量。这些变量可用于创建标准化风险分层工具，纳入血管造影术候选者的循证指南。
