R. J. Miskimins1, L. R. Webb1, S. D. West1, A. N. Delu2, S. W. Lu1 1University Of New Mexico HSC,Department Of Surgery,Albuquerque, NM, USA 2University Of New Mexico HSC,Department Of Radiology,Albuquerque, NM, USA
Introduction:
Multiple methods of hemorrhage control associated with pelvic fractures have been described. At our Level 1 Trauma center, the primary method used is placement of a pelvic binder followed by angioembolization. Angioembolization is performed by a interventional radiology (IR) team which is not in house at night or on weekends. We hypothesized that individuals with pelvic hemorrhage requiring embolization who present to the emergency department (ED) after business hours have an increased time to angioembolization, require more blood products, and have a higher mortality compared to those presenting during business hours.
Methods:
The IR database was used to identify individuals who underwent emergent pelvic angioembolization secondary to blunt trauma from January 2008 to December 2013. These were divided into, the business hours (BH) group, defined as those presenting to the ED between 7:30 AM and 5:30 PM Monday to Friday and the after business hours group (ABH) defined as those presenting to the ED on weekends, holidays or between the hours of 5:30 PM and 7:30 AM. A chart review was used to obtain the time of ED presentation, presence of contrast extravasation on CT, start time of angioembolization, units of packed red blood cells (PRBC) transfused and if the patient went to the operating room prior to IR. The trauma database was used to obtain initial vitals, demographics, ISS and mortality. Continuous variables were analyzed with the Mann Whitney U test and categorical data was analyzed using the Fisher exact test.
Results:
Ninety nine patients meet inclusion criteria (64 ABH vs 35 BH). There was no difference in initial vitals or demographics. The ISS was similar between the groups (median, 27 ABH vs 26 minutes BH). A blush was present on CT in 63% of the ABH vs 57% in the BH (p=0.67). 25% of the ABH went to the OR prior to IR vs 17% in the BH (p=0.45). There was no difference in PRBCs transfused (median, 6.5 ABH vs 5 BH, p=0.27). There was a significant difference in the time to IR (median, 304 minutes ABH vs 219 minutes BH). Ten patients died within 30 days in the ABH vs 6 in the BH group (p=0.78). There were five deaths from hemorrhage in the first 24 hours in the ABH compared to one in the BH group (p=0.32).
Conclusion:
Individuals who arrive after hours, on weekends, or holidays who require angioembolization to control pelvic hemorrhage, require more time to arrive in the IR suite for management. Although they require more time to arrive in the IR suite, our data does not demonstrate an increase in 30 day mortality, the number of PRBCs transfused, or the number of patients who died from hemorrhage in the ABH group. A limitation of our study is the ability to determine the number of patients who died in both groups while waiting for IR. We have demonstrated there is an increased time to pelvic angioembolization in those presenting outside of business hours, however, there is no difference in mortality if the patient is able to arrive in IR.